Although ventilated and sedated, with temporary pacing wires and box on a back-up mode and a low dose of
inotropes (noradrenalin), the patient is fairly stable.
Dopamine was the most common first-line
inotrope (71%), with dobutamine (23%) and adrenaline (6%).
Rows are organized according to treatments, i.e., baseline ("vehicle"), positive
inotrope ("Isoproterenol"), negative
inotrope ("Propranolol"), and hERG channel inhibitor ("Cisapride").
Considering the number of patients requiring
inotrope and the duration of
inotrope support in these patients, no significant statistical difference was observed.
Altered sensorium,
inotrope use, CPR, and APACHE II score > 20 had the highest relative risk of mortality.
* Patients who are refractory to fluid management may require
inotrope support, which can be given via the peripheral vascular route.
The saphena wound site infection, mediastinitis, reintubation, bleeding or revision due to sternal dehiscence, temporary neurological deficit,
inotrope and intra-aortic balloon pump requirement (IABP) were the factors extending the emergency care and hospital stay duration and increasing the morbidity.
Mortality was higher in patients with two (35.7%), three (3.3%) or more
inotropes (80%) than in those with one
inotrope (12.1%) or without (2%, p<.0001).
The occurrence of postoperative myocardial infarctions, new onset atrial fibrillation, re-operation for bleeding, vasopressor support in SICU,
inotrope support in SICU, and postoperative requirement for intra-aortic balloon pump are indicators of hemodynamic instability.
Inotropes have been shown to be associated with a worse outcome, but milrinone, which is both an
inotrope and a vasodilator, may be associated with some improvement in outcome.
An exclusive license for the rights to United States Patent 5,629,298, "Adenosine as a Positive
Inotrope in the Compromised Heart" has been executed with UMMS.
The company says an Investigational Device Exemption (IDE) and Category B were approved by the FDA in connection with the Feasibility Study for Destination Therapy, named INTrEPID (Investigation of Non-Transplant-Eligible Patients who are
Inotrope Dependent).