Speaker
Benjamin Hibbert, MD, PhD
Clinician Scientist and Interventional Cardiologist
University of Ottawa Heart Institute
Topic
Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock: the DOREMI trial
Keywords
Randomized pragmatic clinical trial; Milrinone; Dobutamine; CAPITAL DOREMI; Cardiogenic Shock; Evidenced based research
Key Points
- Many therapies in cardiology and critical care are based on lower quality data, creating a large knowledge gap between the therapies used and the evidence to support their use.
- Powerful randomized clinical trials are needed to evaluate and support the therapies used in clinical care.
- Cardiogenic Shock, a common presentation with a mortality rate of 40% to 50%, has limited effective therapies and very limited data to support the therapies that are used.
- The CAPITAL DOREMI trial was a double-blind randomized pragmatic clinical trial focused on the hypotheses that Milrinone would reduce the composite primary outcome compared to Dobutamine.
- No significant differences were found between Milrinone and Dobutamine, and selection of one therapy over the other could be based on physician comfort and preference.
- A future trial, CAPITAL DOREMI-2, will investigate the use of an inotrope vs placebo for Cardiogenic Shock.
Discussion Themes
Are medical physicians so anxious to help their desperately ill patients that they gravitate toward doing something, even when there isn’t high quality evidence that it helps?
The therapies used by critical care physicians do not always have a great foundation of evidence. As a field, critical care physicians should be developing this evidence base with pragmatic clinical trials.
Read more about Dr. Hibbert’s work with the CAPITAL DOREMI study.
Tags
#pctGR, @Collaboratory1