Comparative Efficacy of Noradrenaline vs. Other Vasopressors on Outcomes in Patients With Cardiogenic Shock ― A Systematic Review and Meta-Analysis ―
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background: Because the optimal choice of vasopressor for the initial treatment of cardiogenic shock (CS) remains controversial, we conducted a systematic review and meta-analysis to evaluate whether noradrenaline improves clinical outcomes compared with other vasopressors (adrenaline, dopamine, and vasopressin) in patients with CS. Methods and Results: PubMed, CENTRAL, and Web of Science databases were searched for randomized controlled trials (RCTs) and observational studies comparing noradrenaline with other vasopressors in adults with CS. A meta-analysis was conducted using fixed-effect models where appropriate. Two RCTs were included (n=337). One trial enrolled 57 patients and compared the effects of noradrenaline and adrenaline. Another study included 280 patients with CS as a subgroup and compared noradrenaline with dopamine. Pooled analysis showed that noradrenaline likely reduced the 28-day mortality rate compared with other vasopressors (very-low certainty). This corresponded to approximately 110 fewer deaths per 1000 patients (95% confidence interval: 217 fewer to 5 fewer). Secondary outcomes from the Levy study indicated fewer adverse events in the noradrenaline group. Conclusions: Noradrenaline likely reduces the 28-day mortality rate compared with other vasopressors (very-low certainty) in CS. Given the small number of studies and the potential bias, further large-scale trials are warranted.
Source: Circulation Reports
Authors: Yumiko Hosoya, Masahiro Yamamoto, Hiroyuki Hanada, Takumi Osawa, Marina Arai, Kazuo Sakamoto, Yusuke Okazaki, Aya Katasako-Yabumoto, Tomoko Ishizu, Toru Kondo, Jin Kirigaya, Naoki Nakayama, Takeshi Yamamoto, Katsutaka Hashiba, Takahiro Nakashima, Teruo Noguchi, Yasushi Tsujimoto, Migaku Kikuchi, Toshikazu Funazaki, Yoshio Tahara, Hiroshi Nonogi, Tetsuya Matoba
Institutions: Sakakibara Hospital, Kumamoto University Hospital, Hirosaki University, University of Tsukuba Hospital, Tohoku University, Kyushu University Hospital, Steel Memorial Muroran Hospital, National Cerebral and Cardiovascular Center, Nagoya University, Yokohama City University Medical Center, Nippon Medical School Hospital, Scientific Research WorkS Peer Support Group, Dokkyo University, Dokkyo Medical University, Shizuoka University, University of Shizuoka, Kyushu University
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: diamond
OpenAlex ID: W4415975102