Comparative Efficacy of Noradrenaline vs. Other Vasopressors on Outcomes in Patients With Cardiogenic Shock ― A Systematic Review and Meta-Analysis ―
作者：Yumiko Hosoya, Masahiro Yamamoto, Hiroyuki Hanada, Takumi Osawa, Marina Arai, Kazuo Sakamoto, Yusuke Okazaki, Aya Katasako-Yabumoto, Tomoko Ishizu, Torû Kondô, Jin Kirigaya, Naoki Nakayama, Takeshi Yamamoto, Katsutaka Hashiba, Takahiro Nakashima, Teruo Noguchi, Yasushi Tsujimoto, Migaku Kikuchi, Toshikazu Funazaki, Yoshio Tahara, Hiroshi Nonogi, Tetsuya Matoba · 发表于：Circulation Reports · 年份：2025 · DOI：10.1253/circrep.cr-25-0188 · 被引用次数：4 · 研究领域：Mechanical Circulatory Support Devices、Sepsis Diagnosis and Treatment、Cardiac Arrest and Resuscitation
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.