Role of Dopamine in ACLS for Hypotension

Dopamine is recommended for hypotension in ACLS, particularly when associated with symptomatic bradycardia, at doses of 5-10 mcg/kg/min. 1, 2

Indications for Dopamine in ACLS

Dopamine is indicated for the correction of hemodynamic imbalances present in shock due to myocardial infarction, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation 2
Specifically recommended for hypotension, especially when associated with symptomatic bradycardia 1
Can be used when bradycardia is unresponsive to atropine, as an alternative to transcutaneous pacing 1, 3
May be considered in patients with symptomatic bradycardia when atropine may be inappropriate or after atropine fails 1

Initial recommended dose for hypotension in ACLS is 5-10 mcg/kg/min 1
Dose-dependent effects of dopamine include:
- Low doses (1-2 mcg/kg/min): Predominantly dopaminergic effects (renal vasodilation) 1, 4
- Intermediate doses (3-5 mcg/kg/min): Inotropic effects (β-adrenergic) 4, 2
- Higher doses (>10 mcg/kg/min): Vasopressor effects (α-adrenergic) 4, 2
Titration should be based on patient response, with increments of 5-10 mcg/kg/min as needed 4, 2
Maximum doses typically should not exceed 50 mcg/kg/min due to increased risk of adverse effects 2

Continuous monitoring of vital signs including blood pressure, heart rate, and ECG is essential 4, 5
Arterial line placement is recommended when practical for patients requiring vasopressors 4
Monitor urine output as a marker of adequate perfusion; diminished urine flow may indicate need for dose adjustment 2
Watch for signs of excessive tachycardia or new dysrhythmias, which may necessitate decreasing or temporarily suspending the dosage 2

Although low-dose dopamine infusion has frequently been recommended to maintain renal blood flow or improve renal function, more recent data have failed to show a beneficial effect from such therapy 1
In patients with cardiogenic shock, norepinephrine may result in lower mortality compared to dopamine 1
Dopamine may worsen myocardial oxygenation in patients with acute myocardial infarction, potentially being harmful to acutely ischemic myocardium 6
Current guidelines suggest norepinephrine as the first-choice vasopressor for septic shock, with dopamine used only in highly selected patients with low risk of tachyarrhythmias 1, 4

Dopamine should be infused into a large vein whenever possible to prevent infiltration of perivascular tissue 2
Extravasation may cause necrosis and sloughing of surrounding tissue; if extravasation occurs, infiltrate 5-10 mg of phentolamine diluted in 10-15 mL of saline into the site 1, 2
Administration requires an infusion pump, preferably a volumetric pump, not just gravity and mechanical clamps 2
When discontinuing the infusion, gradually decrease the dose while expanding blood volume with intravenous fluids to prevent marked hypotension 2

Epinephrine (0.1-0.5 mcg/kg/min) is useful for severe hypotension and symptomatic bradycardia if atropine and transcutaneous pacing fail 1, 3
Norepinephrine (0.1-0.5 mcg/kg/min) is recommended for severe hypotension with low peripheral resistance 1
In post-cardiac arrest care, vasopressors may be needed to support circulation, with norepinephrine often preferred over dopamine due to lower risk of tachyarrhythmias 1