xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT05999487</url>
    </required_header>
    <id_info>
      <org_study_id>inotropes in pediatrics</org_study_id>
      <nct_id>NCT05999487</nct_id>
    </id_info>
    <brief_title>Dobutamine Versus Milrinone in Management of Critically Ill Low Cardiac Output Pediatric Patients at Cairo University Children's Hospital</brief_title>
    <official_title>Dobutamine Versus Milrinone in Management of Critically Ill Low Cardiac Output Pediatric Patients at Cairo University Children's Hospital</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Cairo University</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>Cairo University</source>
    <oversight_info>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        The aim of the study is to detect wither dobutamine or milrinone have a privilege in the&#xD;
        management of low cardiac output pediatric patients over the other.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        Randomized controlled trials (RCTs) enrolling critically ill patients with low cardiac output&#xD;
        syndrome (LCOS) admitted at pediatrics emergency and intensive care units ,Cairo University&#xD;
        Children's Hospital, identified by treating medical team as requiring initiation of inotropic&#xD;
        therapy based on healthcare team assessment of :&#xD;
  &#xD;
          -  Capillary refill time &gt; 3 sec&#xD;
  &#xD;
          -  Hypotension (less than the 5th percentile or less than 90/50 mmHg for children 10 years&#xD;
             or older (Kleinman et al.,2010) (Haque et al .,2007)&#xD;
  &#xD;
          -  Oliguria (urine output that is less than 1 mL/kg/h in infants, less than 0.5 mL/kg/h in&#xD;
             children ) (Nakano et al.,2022)&#xD;
  &#xD;
          -  Metabolic acidosis with base excess &gt; -2 (Nakano et al.,2020)&#xD;
  &#xD;
        Patient randomization will be done by a computer based generation , serial enveloped numbers&#xD;
        will be taken for the patients. Cardiac assessment will be done by a blinded pediatric&#xD;
        cardiologist. If at any time the randomly assigned therapy considered to be failed or unsafe&#xD;
        to continue, the treating physician will discontinue randomization and will continue with the&#xD;
        appropriate medication according to the patients need.&#xD;
  &#xD;
        Every patient will be evaluated after the first 24 hours of starting the inotropic therapy by&#xD;
        :&#xD;
  &#xD;
          -  pre and post inotropic therapy ICON measurements ( evaluating cardiac index and systemic&#xD;
             vascular resistance pre and post inotropic support)&#xD;
  &#xD;
          -  pre and post inotropic therapy echocardiography ( evaluating systolic and diastolic&#xD;
             dysfunction by M-mode and two dimensional methods) through measuring LV EDD cm, LV ESD&#xD;
             cm, LV EDV ml, LVESV ml, FS% , LV mass, EF% , MAPSE cm, TAPSE cm.&#xD;
  &#xD;
          -  pre and post inotropic therapy clinical assessment of vital signs (heart rate , blood&#xD;
             pressure, capillary refill time and urine output as mention before)&#xD;
  &#xD;
          -  The need of titration up of inotropes :&#xD;
  &#xD;
        Milrinone will start by 0.25 , 0.5 , 0.75 we can titrate up with time interval 3 hours after&#xD;
        re-assessment.&#xD;
  &#xD;
        Dobutamine will start by 5, 10 , 15, 20 we can titrate with time interval 15 mins after&#xD;
        re-assesment.&#xD;
  &#xD;
        -Time to achievement of therapeutic endpoints for hemodynamics&#xD;
  &#xD;
          -  adequate blood pressure&#xD;
  &#xD;
          -  clinically adequate cardiac output ( capillary refill time &lt; 2sec , urine output that is&#xD;
             more than 1 mL/kg/h in infants, more than 0.5 mL/kg/h in children, full conscious )&#xD;
  &#xD;
        Data will be collected for each patient in form of [ Time Frame: Through first 24 hours up to&#xD;
        first week since admission ] :&#xD;
  &#xD;
          1. Total time on inotropes (in hours)&#xD;
  &#xD;
          2. Non-invasive or invasive mechanical ventilation Total number of days requiring&#xD;
             non-invasive or invasive mechanical ventilation&#xD;
  &#xD;
          3. Change in cardiac index ([CI] measured with ICON&#xD;
  &#xD;
          4. Change in systemic vascular resistance [SVR] measured with ICON&#xD;
  &#xD;
          5. Presence of acute kidney injury (defined as an increase in serum creatinine or a&#xD;
             decrease in urine output or both over hours to days.) (Jacob J et al.,2020)&#xD;
  &#xD;
          6. Absence of metabolic acidosis (BE -2 to 2)&#xD;
  &#xD;
          7. Arrhythmia requiring medical team intervention, either through electrical or chemical&#xD;
             cardioversion or any intravenous anti-arrhythmia medication administration&#xD;
  &#xD;
          8. Need for up-titration or addition of new vasopressor therapy&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">October 2023</start_date>
    <completion_date type="Anticipated">May 2024</completion_date>
    <primary_completion_date type="Anticipated">March 2024</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Crossover Assignment</intervention_model>
      <primary_purpose>Treatment</primary_purpose>
      <masking>Single (Investigator)</masking>
      <masking_description>. Cardiac assessment will be done by a blinded pediatric cardiologist.</masking_description>
    </study_design_info>
    <primary_outcome>
      <measure>time to achievemnets of theraputeic endpoints of hemodynamics</measure>
      <time_frame>first 24 hrs</time_frame>
      <description>( normal blood pressure and clinically adequate cardiac output)</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Correlation between the used inotropic support and the survival to discharge .</measure>
      <time_frame>first week</time_frame>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Total time on inotropes and average length of stay at a pediatric intensive care unit.</measure>
      <time_frame>first week</time_frame>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Need for up-titration or addition of other inotropic support.</measure>
      <time_frame>first 24 hrs</time_frame>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Frequency of arrythmias and side effects encountered with the use of inotropic support in pediatrics population.</measure>
      <time_frame>first 24 hrs</time_frame>
    </secondary_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Anticipated">40</enrollment>
    <condition>Dobutamine, Milrinone , Pediatrics , Low Cardiac Output</condition>
    <arm_group>
      <arm_group_label>patients who will recieve dobutrex</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>patient presenting with acute heart failure , who will recieve dobutrex as a result of their randomixation , startng dose will be 5 mic , assesing their need for tittration of dose , the need for addition of another inotrope , the prescence of any side effects and the duration of inotropic use for reaching hemodynamically stable state</description>
    </arm_group>
    <arm_group>
      <arm_group_label>patients who will recieve milirinone</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>patient presenting with acute heart failure , who will recieve milirinone as a result of their randomixation , startng dose will be 0.25 mic , assesing their need for tittration of dose , the need for addition of another inotrope , the prescence of any side effects and the duration of inotropic use for reaching hemodynamically stable state</description>
    </arm_group>
    <intervention>
      <intervention_type>Drug</intervention_type>
      <intervention_name>Dobutamine</intervention_name>
      <description>Patient randomization will be done by a computer based generation , serial enveloped numbers will be taken for the patients. Cardiac assessment will be done by a blinded pediatric cardiologist. If at any time the randomly assigned therapy considered to be failed or unsafe to continue, the treating physician will discontinue randomization and will continue with the appropriate medication according to the patients need.&#xD;
  Milrinone will start by 0.25 , 0.5 , 0.75 we can titrate up with time interval 3 hours after re-assessment.&#xD;
  Dobutamine will start by 5, 10 , 15, 20 we can titrate with time interval 15 mins after re-assesment.</description>
      <arm_group_label>patients who will recieve dobutrex</arm_group_label>
      <arm_group_label>patients who will recieve milirinone</arm_group_label>
      <other_name>milrinone</other_name>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  1-Patients from age of 1 month to 14 years old of both sexes.&#xD;
  &#xD;
               2-Patients presenting with fluid refractory shock with low cardiac output state,&#xD;
               evidenced by sustained hypotension (systolic blood pressure below 5th percentile for&#xD;
               age) and end organ dysfunction (altered level of consciousness, renal or hepatic&#xD;
               dysfunction)&#xD;
  &#xD;
               3-Clinical evidence of systemic and/or pulmonary congestion despite use of&#xD;
               vasodilators and/or diuretics&#xD;
  &#xD;
               4-Refractory heart failure requiring admission for inotropic support.&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
          1-All other causes of pediatric shock not in need for inotropic support (eg.isolated&#xD;
          hypovolemic shock, anaphylaxis,….)&#xD;
  &#xD;
          2 - patients not fit for randomization needing specific line of management (eg. Sever&#xD;
          hypotension patients with good filling pressure unfit for milrinone , patients previously&#xD;
          known having sever pulmonary hypertension not fit for dobutamine ,…)&#xD;
  &#xD;
          3-post cardiac surgery patients with low cardiac output manifestation.&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>1 Month</minimum_age>
      <maximum_age>14 Years</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_contact>
      <last_name>nada gamal</last_name>
      <phone>01062094645</phone>
      <email>nada.g276@gmail.com</email>
    </overall_contact>
    <overall_contact_backup>
      <last_name>Hafez Bazraa, professor</last_name>
      <phone>01222235316</phone>
      <email>hmbazaraa@kasralainy.edu.eg</email>
    </overall_contact_backup>
    <location>
      <facility>
        <name>Cairo University Children'S Hospital</name>
        <address>
          <city>Giza</city>
          <zip>11511</zip>
          <country>Egypt</country>
        </address>
      </facility>
    </location>
    <location_countries>
      <country>Egypt</country>
    </location_countries>
    <reference>
      <citation>Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med. 2007 Mar;8(2):138-44. doi: 10.1097/01.PCC.0000257039.32593.DC.</citation>
      <PMID>17273118</PMID>
    </reference>
    <reference>
      <citation>Jacob J, Dannenhoffer J, Rutter A. Acute Kidney Injury. Prim Care. 2020 Dec;47(4):571-584. doi: 10.1016/j.pop.2020.08.008. Epub 2020 Oct 1.</citation>
      <PMID>33121629</PMID>
    </reference>
    <reference>
      <citation>Jentzer JC, Coons JC, Link CB, Schmidhofer M. Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit. J Cardiovasc Pharmacol Ther. 2015 May;20(3):249-60. doi: 10.1177/1074248414559838. Epub 2014 Nov 28.</citation>
      <PMID>25432872</PMID>
    </reference>
    <reference>
      <citation>Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR, Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, van der Jagt EW, Zaritsky AL; American Heart Association. Pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2010 Nov;126(5):e1361-99. doi: 10.1542/peds.2010-2972D. Epub 2010 Oct 18. No abstract available.</citation>
      <PMID>20956434</PMID>
    </reference>
    <reference>
      <citation>Lewis TC, Aberle C, Altshuler D, Piper GL, Papadopoulos J. Comparative Effectiveness and Safety Between Milrinone or Dobutamine as Initial Inotrope Therapy in Cardiogenic Shock. J Cardiovasc Pharmacol Ther. 2019 Mar;24(2):130-138. doi: 10.1177/1074248418797357. Epub 2018 Sep 2.</citation>
      <PMID>30175599</PMID>
    </reference>
    <reference>
      <citation>Mathew R, Di Santo P, Jung RG, Marbach JA, Hutson J, Simard T, Ramirez FD, Harnett DT, Merdad A, Almufleh A, Weng W, Abdel-Razek O, Fernando SM, Kyeremanteng K, Bernick J, Wells GA, Chan V, Froeschl M, Labinaz M, Le May MR, Russo JJ, Hibbert B. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med. 2021 Aug 5;385(6):516-525. doi: 10.1056/NEJMoa2026845.</citation>
      <PMID>34347952</PMID>
    </reference>
    <reference>
      <citation>Masse L, Antonacci M. Low cardiac output syndrome: identification and management. Crit Care Nurs Clin North Am. 2005 Dec;17(4):375-83, x. doi: 10.1016/j.ccell.2005.07.005.</citation>
      <PMID>16344207</PMID>
    </reference>
    <reference>
      <citation>Nakano H, Nagai T, Honda Y, Honda S, Iwakami N, Matsumoto C, Asaumi Y, Aiba T, Noguchi T, Kusano K, Yokoyama H, Ogawa H, Yasuda S, Chikamori T, Anzai T. Prognostic value of base excess as indicator of acid-base balance in acute heart failure. Eur Heart J Acute Cardiovasc Care. 2020 Aug;9(5):399-405. doi: 10.1177/2048872619898781. Epub 2020 Jan 23.</citation>
      <PMID>31970993</PMID>
    </reference>
    <reference>
      <citation>Nakano H. Oliguria. https://emedicine.medscape.com/article/983156-overview. Updated: Feb 28, 2022. Accessed at 15-12-2022.</citation>
    </reference>
    <reference>
      <citation>Uhlig K, Efremov L, Tongers J, Frantz S, Mikolajczyk R, Sedding D, Schumann J. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev. 2020 Nov 5;11(11):CD009669. doi: 10.1002/14651858.CD009669.pub4.</citation>
      <PMID>33152122</PMID>
    </reference>
    <verification_date>August 2023</verification_date>
    <study_first_submitted>May 5, 2023</study_first_submitted>
    <study_first_submitted_qc>August 17, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 21, 2023</study_first_posted>
    <last_update_submitted>August 17, 2023</last_update_submitted>
    <last_update_submitted_qc>August 17, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">August 21, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Principal Investigator</responsible_party_type>
      <investigator_affiliation>Cairo University</investigator_affiliation>
      <investigator_full_name>Nada Gamal</investigator_full_name>
      <investigator_title>pediatric resident</investigator_title>
    </responsible_party>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Cardiac Output, Low</mesh_term>
    </condition_browse>
    <intervention_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Dobutamine</mesh_term>
      <mesh_term>Milrinone</mesh_term>
    </intervention_browse>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT05999487
  org study id: inotropes in pediatrics
  nct id: NCT05999487
  lead sponsor: 
  is fda regulated drug: No
  is fda regulated device: No
  The aim of the study is to detect wither dobutamine or milrinone have a privilege in the
        management of low cardiac output pediatric patients over the other.
  Randomized controlled trials (RCTs) enrolling critically ill patients with low cardiac output
        syndrome (LCOS) admitted at pediatrics emergency and intensive care units ,Cairo University
        Children's Hospital, identified by treating medical team as requiring initiation of inotropic
        therapy based on healthcare team assessment of :
  
          -  Capillary refill time > 3 sec
  
          -  Hypotension (less than the 5th percentile or less than 90/50 mmHg for children 10 years
             or older (Kleinman et al.,2010) (Haque et al .,2007)
  
          -  Oliguria (urine output that is less than 1 mL/kg/h in infants, less than 0.5 mL/kg/h in
             children ) (Nakano et al.,2022)
  
          -  Metabolic acidosis with base excess > -2 (Nakano et al.,2020)
  
        Patient randomization will be done by a computer based generation , serial enveloped numbers
        will be taken for the patients. Cardiac assessment will be done by a blinded pediatric
        cardiologist. If at any time the randomly assigned therapy considered to be failed or unsafe
        to continue, the treating physician will discontinue randomization and will continue with the
        appropriate medication according to the patients need.
  
        Every patient will be evaluated after the first 24 hours of starting the inotropic therapy by
        :
  
          -  pre and post inotropic therapy ICON measurements ( evaluating cardiac index and systemic
             vascular resistance pre and post inotropic support)
  
          -  pre and post inotropic therapy echocardiography ( evaluating systolic and diastolic
             dysfunction by M-mode and two dimensional methods) through measuring LV EDD cm, LV ESD
             cm, LV EDV ml, LVESV ml, FS% , LV mass, EF% , MAPSE cm, TAPSE cm.
  
          -  pre and post inotropic therapy clinical assessment of vital signs (heart rate , blood
             pressure, capillary refill time and urine output as mention before)
  
          -  The need of titration up of inotropes :
  
        Milrinone will start by 0.25 , 0.5 , 0.75 we can titrate up with time interval 3 hours after
        re-assessment.
  
        Dobutamine will start by 5, 10 , 15, 20 we can titrate with time interval 15 mins after
        re-assesment.
  
        -Time to achievement of therapeutic endpoints for hemodynamics
  
          -  adequate blood pressure
  
          -  clinically adequate cardiac output ( capillary refill time < 2sec , urine output that is
             more than 1 mL/kg/h in infants, more than 0.5 mL/kg/h in children, full conscious )
  
        Data will be collected for each patient in form of [ Time Frame: Through first 24 hours up to
        first week since admission ] :
  
          1. Total time on inotropes (in hours)
  
          2. Non-invasive or invasive mechanical ventilation Total number of days requiring
             non-invasive or invasive mechanical ventilation
  
          3. Change in cardiac index ([CI] measured with ICON
  
          4. Change in systemic vascular resistance [SVR] measured with ICON
  
          5. Presence of acute kidney injury (defined as an increase in serum creatinine or a
             decrease in urine output or both over hours to days.) (Jacob J et al.,2020)
  
          6. Absence of metabolic acidosis (BE -2 to 2)
  
          7. Arrhythmia requiring medical team intervention, either through electrical or chemical
             cardioversion or any intravenous anti-arrhythmia medication administration
  
          8. Need for up-titration or addition of new vasopressor therapy
  allocation: Randomized
  intervention model: Crossover Assignment
  primary purpose: Treatment
  masking: Single (Investigator)
  masking description: . Cardiac assessment will be done by a blinded pediatric cardiologist.
  measure: time to achievemnets of theraputeic endpoints of hemodynamics
  time frame: first 24 hrs
  description: ( normal blood pressure and clinically adequate cardiac output)
  measure: Correlation between the used inotropic support and the survival to discharge .
  time frame: first week
  measure: Total time on inotropes and average length of stay at a pediatric intensive care unit.
  time frame: first week
  measure: Need for up-titration or addition of other inotropic support.
  time frame: first 24 hrs
  measure: Frequency of arrythmias and side effects encountered with the use of inotropic support in pediatrics population.
  time frame: first 24 hrs
  arm group label: patients who will recieve dobutrex
  arm group type: Active Comparator
  description: patient presenting with acute heart failure , who will recieve dobutrex as a result of their randomixation , startng dose will be 5 mic , assesing their need for tittration of dose , the need for addition of another inotrope , the prescence of any side effects and the duration of inotropic use for reaching hemodynamically stable state
  arm group label: patients who will recieve milirinone
  arm group type: Experimental
  description: patient presenting with acute heart failure , who will recieve milirinone as a result of their randomixation , startng dose will be 0.25 mic , assesing their need for tittration of dose , the need for addition of another inotrope , the prescence of any side effects and the duration of inotropic use for reaching hemodynamically stable state
  intervention type: Drug
  intervention name: Dobutamine
  description: Patient randomization will be done by a computer based generation , serial enveloped numbers will be taken for the patients. Cardiac assessment will be done by a blinded pediatric cardiologist. If at any time the randomly assigned therapy considered to be failed or unsafe to continue, the treating physician will discontinue randomization and will continue with the appropriate medication according to the patients need.
  Milrinone will start by 0.25 , 0.5 , 0.75 we can titrate up with time interval 3 hours after re-assessment.
  Dobutamine will start by 5, 10 , 15, 20 we can titrate with time interval 15 mins after re-assesment.
  arm group label: patients who will recieve dobutrex
  arm group label: patients who will recieve milirinone
  other name: milrinone
  criteria: 
  gender: All
  minimum age: 1 Month
  maximum age: 14 Years
  healthy volunteers: No
  last name: nada gamal
  phone: 01062094645
  email: nada.g276@gmail.com
  last name: Hafez Bazraa, professor
  phone: 01222235316
  email: hmbazaraa@kasralainy.edu.eg
  facility: 
  country: Egypt
  citation: Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med. 2007 Mar;8(2):138-44. doi: 10.1097/01.PCC.0000257039.32593.DC.
  PMID: 17273118
  citation: Jacob J, Dannenhoffer J, Rutter A. Acute Kidney Injury. Prim Care. 2020 Dec;47(4):571-584. doi: 10.1016/j.pop.2020.08.008. Epub 2020 Oct 1.
  PMID: 33121629
  citation: Jentzer JC, Coons JC, Link CB, Schmidhofer M. Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit. J Cardiovasc Pharmacol Ther. 2015 May;20(3):249-60. doi: 10.1177/1074248414559838. Epub 2014 Nov 28.
  PMID: 25432872
  citation: Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR, Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, van der Jagt EW, Zaritsky AL; American Heart Association. Pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2010 Nov;126(5):e1361-99. doi: 10.1542/peds.2010-2972D. Epub 2010 Oct 18. No abstract available.
  PMID: 20956434
  citation: Lewis TC, Aberle C, Altshuler D, Piper GL, Papadopoulos J. Comparative Effectiveness and Safety Between Milrinone or Dobutamine as Initial Inotrope Therapy in Cardiogenic Shock. J Cardiovasc Pharmacol Ther. 2019 Mar;24(2):130-138. doi: 10.1177/1074248418797357. Epub 2018 Sep 2.
  PMID: 30175599
  citation: Mathew R, Di Santo P, Jung RG, Marbach JA, Hutson J, Simard T, Ramirez FD, Harnett DT, Merdad A, Almufleh A, Weng W, Abdel-Razek O, Fernando SM, Kyeremanteng K, Bernick J, Wells GA, Chan V, Froeschl M, Labinaz M, Le May MR, Russo JJ, Hibbert B. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med. 2021 Aug 5;385(6):516-525. doi: 10.1056/NEJMoa2026845.
  PMID: 34347952
  citation: Masse L, Antonacci M. Low cardiac output syndrome: identification and management. Crit Care Nurs Clin North Am. 2005 Dec;17(4):375-83, x. doi: 10.1016/j.ccell.2005.07.005.
  PMID: 16344207
  citation: Nakano H, Nagai T, Honda Y, Honda S, Iwakami N, Matsumoto C, Asaumi Y, Aiba T, Noguchi T, Kusano K, Yokoyama H, Ogawa H, Yasuda S, Chikamori T, Anzai T. Prognostic value of base excess as indicator of acid-base balance in acute heart failure. Eur Heart J Acute Cardiovasc Care. 2020 Aug;9(5):399-405. doi: 10.1177/2048872619898781. Epub 2020 Jan 23.
  PMID: 31970993
  citation: Nakano H. Oliguria. https://emedicine.medscape.com/article/983156-overview. Updated: Feb 28, 2022. Accessed at 15-12-2022.
  citation: Uhlig K, Efremov L, Tongers J, Frantz S, Mikolajczyk R, Sedding D, Schumann J. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev. 2020 Nov 5;11(11):CD009669. doi: 10.1002/14651858.CD009669.pub4.
  PMID: 33152122
  responsible party type: Principal Investigator
  investigator affiliation: Cairo University
  investigator full name: Nada Gamal
  investigator title: pediatric resident
  mesh term: Cardiac Output, Low
  mesh term: Dobutamine
  mesh term: Milrinone