Treatment of circulatory shock with dopamine. Studies on survival

Abstract

Therapeutic effects of dopamine hydrochloride on the peripheral and metabolic defects of shock were investigated in 34 patients with circulatory shock associated with myocardial infarction, bacteremia or hypovolemia. Severity of the circulatory defect characterized by hypotension, reduced cardiac output, oliguria and notably reduced skin (toe) temperature before treatment with dopamine was not directly related to survival. Arterial blood concentration of lactate before treatment with dopamine predicted the likelihood of survival. Patients who ultimately survived following treatment with dopamine had normal or only mildly elevated levels of arterial blood lactate before therapy. No patients with established shock states in whom perfusion failure was associated with substantial increases in the level of arterial blood lactate survived regardless of treatment with dopamine. Increases in toe temperature during dopamine treatment emerged as a uniquely good indicator of favorable outcome during therapy.