LAUSR

Learning Objectives: Adverse outcomes have been reported with high doses of different catecholamines for treatment of cardiogenic shock, yet the comparative safety and efficacy of lower doses of these drugs is not well-described. We sought to compare clinical outcomes using low doses of catecholamines in cardiac intensive care unit (CICU) patients, including patients with and without cardiogenic shock. Methods: Using a database of 10,004 unique CICU patients admitted from January 2007 to December 2015, we retrospectively identified patients receiving a single low-dose catecholamine during the CICU stay, defined as dobutamine/dopamine <=10 mcg/ kg/min or epinephrine/norepinephrine <=0.1 mcg/kg/min. Catecholamine groups were compared using ANOVA and chi-squared tests. Predictors of hospital mortality were determined using multivariate logistic regression following stepwise variable selection. Results: We included 680 patients with a mean age of 68.7 years, of whom 229 (33.7%) were female. Discharge diagnoses included shock in 20.9%, cardiogenic shock in 17.7% (84.5% of all patients with shock), cardiac arrest in 14.7%, heart failure in 57.8% and acute coronary syndrome in 42.0%. Patients receiving dobutamine (n = 92), dopamine (n = 418), epinephrine (n = 77) and norepinephrine (n = 93) differed in terms of demographics, diagnoses, illness severity and CICU therapies; patients receiving norepinephrine had the highest illness severity. Hospital mortality occurred in 97 (14.3%) patients. Unadjusted hospital mortality was not different between groups (p = 0.56): dobutamine 12.0%, dopamine 14.4%, epinephrine 11.7%, norepinephrine 18.3%. No differences in hospital mortality between groups were observed after multivariate adjustment for illness severity and other factors (all p >0.1). Conclusions: We did not observe differences in hospital mortality with use of different low-dose catecholamines among unselected CICU patients, either before or after adjustment for illness severity. This suggests that similar outcomes can be achieved with use of any of these low-dose catecholamines as clinically indicated based on patient-specific factors. CCMCritical Care MedicineCrit Care Med0090-3493Lippincott Williams & WilkinsHagerstown, MD CCM