6/28/23, 1:19 AM DOREMI Pathway Feedback Search Clinical Topics Home Studies DOREMI DOREMI Disease Cardiogenic shock Trial question Is milrinone superior to dobutamine for the treatment of cardiogenic shock? Study design Single center Double blinded RCT Population Characteristics of study participants 36.0% female N = 192 64.0% male 192 patients (70 female, 122 male) Inclusion criteria: adult patients with cardiogenic shock Key exclusion criteria: pregnancy, out-of-hospital cardiac arrest, healthcare team preference for use of specific inotrope Interventions N=96 milrinone (at a dose of 0.125 g/kg/min to > 0.500 g/kg/min) N=96 dobutamine (at a dose of 2.5 g/kg/min to > 10.0 g/kg/min) Primary outcome In-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke https://web.pathway.md/studies/recTakOuM3XvgzPWQ 1/2 6/28/23, 1:19 AM DOREMI Pathway diagnosed by a neurologist, or initiation of renal replacement therapy 54.0 % 54 49 40.5 % 27.0 % No significant difference 13.5 % 0.0 % Milrinone Dobutamine No significant difference in in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, TIA or stroke diagnosed by a neurologist, or initiation of RRT (49% vs. 54%; RR 0.9, 95% CI 0.69 to 1.19) Secondary outcomes No significant difference in in-hospital death (37% vs. 43%; RR 0.85, 95% CI 0.6 to 1.21) No significant difference in resuscitated cardiac arrest (7% vs. 9%; HR 0.78, 95% CI 0.29 to 2.07) No significant difference in receipt of mechanical circulatory support (12% vs. 15%; HR 0.78, 95% CI 0.36 to 1.71) Safety outcomes No significant differences in serum lactate level, serum creatinine level, HR, arrhythmias. Conclusion In adult patients with cardiogenic shock, milrinone was not superior to dobutamine with respect to a in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, TIA or stroke diagnosed by a neurologist, or initiation of RRT. Reference Rebecca Mathew, Pietro Di Santo, Richard G Jung et al. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med. 2021 Aug 5;385(6):516-525. Open reference URL https://web.pathway.md/studies/recTakOuM3XvgzPWQ 2/2