Inotropes in cardiogenic shock

Associate Professor Dion Stub, Monash University

2020 Vanguard Grant

Years funded: 2021-2023

Shock is one of the most challenging clinical management scenarios experienced by clinicians, whether in the pre-hospital or hospital settings. It is a syndrome characterised by an imbalance of oxygen delivery and demand particularly in vital organs, with circulatory and septic shock being most common. Shock is a common clinical problem present in one third of patients admitted to an intensive care unit (ICU). Despite the advances in our ability to support these patients with early identification and treatment, the morbidity and mortality of shocked patients remains unacceptably high. In a contemporary international trial examining patients with shock, 50% of patients died despite best therapy. The early phase management of patients with shock may require medications to improve low blood pressure and cardiac output (inotropes and/or vasopressors). The majority of local and international paramedics commonly use adrenaline as a first line agent to treat patients in shock, despite data highlighting potential benefits of an alternative agent noradrenaline.

The PANDA trial will be the first study in the pre-hospital setting to critically evaluate the initial management of patients with shock. The study will be a multi-centre randomized controlled trial, of adrenaline versus Noradrenaline in patients with Shock as diagnosed by paramedics in the pre-hospital setting. The investigator are international leaders in conducting clinical trials in the pre-hospital environment and will randomize 850 patients over 2 years, with as evidenced by the investigators previous trials, the very real potential to impact local and international guidelines.