What is the proportion of dopamine as a suitable choice during return of spontaneous circulation (ROSC) after cardiac arrest?

From the Guidelines

Dopamine is not generally recommended as a first-line vasopressor during return of spontaneous circulation (ROSC) after cardiac arrest, with epinephrine or norepinephrine being preferred in this situation. The use of dopamine as a vasopressor during ROSC is not supported by strong evidence, and its use may be associated with increased risk of arrhythmias, particularly in patients who are already vulnerable after cardiac arrest 1. Additionally, the hemodynamic effects of dopamine are less predictable than those of norepinephrine, as it acts on different receptors depending on the dose used.

Some key points to consider when evaluating the use of dopamine during ROSC include:

• The potential for dopamine to cause arrhythmias, which can be particularly problematic in patients who have just experienced cardiac arrest
• The less predictable hemodynamic effects of dopamine compared to norepinephrine
• The availability of alternative vasopressors, such as epinephrine and norepinephrine, which may be more effective and safer in this situation

In general, the priority after ROSC should be to stabilize blood pressure to maintain adequate cerebral and coronary perfusion. While dopamine may be considered in specific situations, such as significant bradycardia accompanying hypotension, other therapeutic options are often preferred 1. The use of dopamine during ROSC should be carefully considered and individualized based on the patient's specific clinical situation and needs.

From the FDA Drug Label

DOSAGE & ADMINISTRATION ... Suggested Regimen: ... 2. Begin infusion of dopamine hydrochloride solution at doses of 2 to 5 mcg/kg/min in adult or pediatric patients who are likely to respond to modest increments of heart force and renal perfusion In more seriously ill patients, begin infusion of dopamine hydrochloride at doses of 5 mcg/kg/min and increase gradually, using 5 to 10 mcg/kg/min increments, up to a rate of 20 to 50 mcg/kg/min as needed.

The proportion of dopamine as a suitable choice during return of spontaneous circulation (ROSC) after cardiac arrest is not explicitly stated in the provided drug label. However, based on the suggested regimen, dopamine can be considered a suitable choice for patients who are likely to respond to modest increments of heart force and renal perfusion, with a starting dose of 2 to 5 mcg/kg/min and gradual increases up to 20 to 50 mcg/kg/min as needed 2.

From the Research

Proportion of Dopamine as a Suitable Choice during Return of Spontaneous Circulation (ROSC) after Cardiac Arrest

• The proportion of dopamine as a suitable choice during ROSC after cardiac arrest is not explicitly stated in the provided studies, but its effectiveness compared to other vasopressors such as norepinephrine is discussed 3, 4, 5, 6, 7.
• A study published in 2010 found that dopamine was associated with a greater number of adverse events, including arrhythmic events, compared to norepinephrine in the treatment of shock 3.
• A 2020 study found no significant difference in 30-day survival and favorable neurologic performance rates between dopamine and norepinephrine in the treatment of hypotension in out-of-hospital cardiac arrest patients with ROSC 4.
• Another study published in 2022 found that norepinephrine was not associated with reductions in in-hospital mortality or arrhythmia, but could reduce the use of additional vasopressors in cardiogenic shock patients 5.
• A 2021 study compared the clinical outcomes of initial norepinephrine or epinephrine for hemodynamic support after ROSC and found that dopamine was used in only 6 patients, which was excluded from reporting due to small sample size 6.
• A 2017 meta-analysis found that norepinephrine was associated with a lower 28-day mortality, a lower risk of arrhythmic events, and gastrointestinal reaction compared to dopamine in the treatment of cardiogenic shock 7.

Comparison of Dopamine and Norepinephrine

• The studies suggest that norepinephrine may be a more suitable choice than dopamine in certain situations, such as cardiogenic shock 5, 7.
• However, the choice of vasopressor may depend on individual patient factors and the specific clinical scenario 3, 4, 6.
• Further study is needed to determine the optimal vasopressor strategy for patients with ROSC after cardiac arrest 6.