Agentes inotrópicos y estrategias vasodilatadoras para el tratamiento del shock cardiogénico o síndrome de gasto cardíaco bajo
Appendices
Appendix 1. Search strategy
CENTRAL
#1 MeSH descriptor: [Shock, Cardiogenic] this term only
#2 (cardiogenic* shock)
#3 MeSH descriptor: [Cardiac Output, Low] this term only
#4 (low near/2 cardiac output)
#5 ((instab* or unstab*) next h?emodynamic)
#6 #1 or #2 or #3 or #4 or #5
#7 MeSH descriptor: [Drug Therapy] this term only
#8 ((drug or medica* or pharmacological) next (therap* or treatment))
#9 MeSH descriptor: [Drug Administration Routes] explode all trees
#10 drug administ*
#11 MeSH descriptor: [Drug Administration Schedule] this term only
#12 #7 or #8 or #9 or #10 or #11
#13 MeSH descriptor: [Cardiotonic Agents] explode all trees
#14 cardiotonic
#15 ((myocardial or cardiac) next stimula*)
#16 inotrope*
#17 inotropic agent*
#18 cardioprotective agent*
#19 acetyldigitoxin*
#20 acetyldigoxin*
#21 adrenomedullin
#22 amrinone
#23 carbachol
#24 cardiac glycoside*
#25 cymarine
#26 deslanoside
#27 digitalis glycoside*
#28 digitoxin
#29 digoxin
#30 dobutamine
#31 dopamine
#32 enoximone
#33 etilefrine
#34 isoproterenol
#35 lisinopril
#36 medigoxin
#37 milrinone
#38 ouabain
#39 oxyfedrine
#40 phenylephrine
#41 prenalterol
#42 proscillaridin
#43 strophanthin*
#44 #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33 or #34 or #35 or #36 or #37 or #38 or #39 or #40 or #41 or #42 or #43
#45 MeSH descriptor: [Vasodilator Agents] explode all trees
#46 vasodilators
#47 vasodilator drug*
#48 vasodilator agent*
#49 vasorelaxant*
#50 vasoactive antagonist*
#51 acetylcholine
#52 adenosine*
#53 adrenomedullin
#54 alprostadil
#55 amlodipine
#56 amyl nitrite
#57 bencyclane
#58 bepridil
#59 betahistine
#60 bradykinin
#61 celiprolol
#62 chromonar
#63 cromakalim
#64 cyclandelate
#65 diazoxide
#66 dihydroergocristine
#67 dihydroergocryptine
#68 dilazep
#69 diltiazem
#70 dipyridamole
#71 dyphylline
#72 ergoloid mesylate*
#73 erythrityl tetranitrate
#74 felodipine
#75 fenoldopam
#76 flunarizine
#77 hexobendine
#78 hydralazine
#79 iloprost
#80 isosorbide dinitrate
#81 isoxsuprine
#82 isradipine
#83 kallidin
#84 lidoflazine
#85 mibefradil
#86 minoxidil
#87 molsidomine
#88 moxisylyte
#89 nafronyl
#90 niacin
#91 nicardipine
#92 nicergoline
#93 nicorandil
#94 nicotinyl alcohol
#95 nifedipine
#96 nimodipine
#97 nisoldipine
#98 nitrendipine
#99 nitroglycerin
#100 nitroprusside
#101 nonachlazine
#102 nylidrin
#103 oxprenolol
#104 oxyfedrine
#105 papaverine
#106 pentaerythritol tetranitrate
#107 pentoxifylline
#108 phenoxybenzamine
#109 pinacidil
#110 pindolol
#111 (Pituitary Adenylate Cyclase‐Activating Polypeptide)
#112 prenylamine
#113 propranolol
#114 (S‐Nitroso‐N‐Acetylpenicillamine)
#115 S‐Nitrosoglutathione
#116 S‐Nitrosothiols
#117 Suloctidil
#118 Theobromine
#119 Tolazoline
#120 Trapidil
#121 (Vasoactive Intestinal Peptide)
#122 Verapamil
#123 Vincamine
#124 (Xanthinol Niacinate)
#125 #45 or #46 or #47 or #48 or #49 or #50 or #51 or #52 or #53 or #54 or #55 or #56 or #57 or #58 or #59 or #60 or #61 or #62 or #63 or #64 or #65 or #66 or #67 or #68 or #69 or #70 or #71 or #72 or #73 or #74 or #75 or #76 or #77 or #78 or #79 or #80 or #81 or #82 or #83 or #84 or #85 or #86 or #87 or #88 or #89 or #90 or #91 or #92 or #93 or #94 or #95 or #96 or #97 or #98 or #99 or #100 or #101 or #102 or #103 or #104 or #105 or #106 or #107 or #108 or #109 or #110 or #111 or #112 or #113 or #114 or #115 or #116 or #117 or #118 or #119 or #120 or #121 or #122 or #123 or #124
#126 MeSH descriptor: [Platelet Aggregation Inhibitors] explode all trees
#127 Epoprostenol
#128 Ketanserin
#129 #126 or #127 or #128
#130 MeSH descriptor: [Phosphodiesterase Inhibitors] this term only
#131 ((phosphodiesterase2 or phosphodiesterase‐2 or phosphodiesteraseII or "phosphodiesterase‐II") next (antagonist*))
#132 ((phosphodiesterase2 or phosphodiesterase‐2 or phosphodiesteraseII or phosphodiesterase‐II) next (inhibitor*))
#133 antiphosphodiesterase*
#134 Caffeine
#135 "calcium sensitiser*"
#136 Levosimendan
#137 #130 or #131 or #132 or #133 or #134 or #135 or #136
#138 tilarginine
#139 #12 or #44 or #125 or #129 or #137 or #138
#140 #6 and #139
MEDLINE Ovid
1. Shock, Cardiogenic/
2. cardiogenic* shock*.tw.
3. Cardiac Output, Low/
4. (low adj2 cardiac output).tw.
5. ((instab* or unstab*) adj h?emodynamic*).tw.
6. or/1‐5
7. Drug Therapy/
8. ((drug or medica* or pharmacological) adj (therap* or treatment)).tw.
9. exp Drug Administration Routes/
10. drug administ*.tw.
11. Drug Administration Schedule/
12. or/7‐11
13. exp Cardiotonic Agents/
14. cardiotonic.tw.
15. ((myocardial or cardiac) adj stimula*).tw.
16. inotrope*.tw.
17. inotropic agent*.tw.
18. cardioprotective agent*.tw.
19. acetyldigitoxin*.tw.
20. acetyldigoxin*.tw.
21. adrenomedullin.tw.
22. amrinone.tw.
23. carbachol.tw.
24. cardiac glycoside*.tw.
25. cymarine.tw.
26. deslanoside.tw.
27. digitalis glycoside*.tw.
28. digitoxin.tw.
29. digoxin.tw.
30. dobutamine.tw.
31. dopamine.tw.
32. enoximone.tw.
33. etilefrine.tw.
34. isoproterenol.tw.
35. lisinopril.tw.
36. medigoxin.tw.
37. milrinone.tw.
38. ouabain.tw.
39. oxyfedrine.tw.
40. phenylephrine.tw.
41. prenalterol.tw.
42. proscillaridin.tw.
43. strophanthin*.tw.
44. or/13‐43
45. exp Vasodilator Agents/
46. vasodilators.tw.
47. vasodilator drug*.tw.
48. vasodilator agent*.tw.
49. vasorelaxant*.tw.
50. vasoactive antagonist*.tw.
51. acetylcholine.tw.
52. adenosine*.tw.
53. adrenomedullin.tw.
54. alprostadil.tw.
55. amlodipine.tw.
56. amyl nitrite.tw.
57. bencyclane.tw.
58. bepridil.tw.
59. betahistine.tw.
60. bradykinin.tw.
61. celiprolol.tw.
62. chromonar.tw.
63. cromakalim.tw.
64. cyclandelate.tw.
65. diazoxide.tw.
66. dihydroergocristine.tw.
67. dihydroergocryptine.tw.
68. dilazep.tw.
69. diltiazem.tw.
70. dipyridamole.tw.
71. dyphylline.tw.
72. ergoloid mesylate*.tw.
73. erythrityl tetranitrate.tw.
74. felodipine.tw.
75. fenoldopam.tw.
76. flunarizine.tw.
77. hexobendine.tw.
78. hydralazine.tw.
79. iloprost.tw.
80. isosorbide dinitrate.tw.
81. isoxsuprine.tw.
82. isradipine.tw.
83. kallidin.tw.
84. lidoflazine.tw.
85. mibefradil.tw.
86. minoxidil.tw.
87. molsidomine.tw.
88. moxisylyte.tw.
89. nafronyl.tw.
90. niacin.tw.
91. nicardipine.tw.
92. nicergoline.tw.
93. nicorandil.tw.
94. nicotinyl alcohol.tw.
95. nifedipine.tw.
96. nimodipine.tw.
97. nisoldipine.tw.
98. nitrendipine.tw.
99. nitroglycerin.tw.
100. nitroprusside.tw.
101. nonachlazine.tw.
102. nylidrin.tw.
103. oxprenolol.tw.
104. oxyfedrine.tw.
105. papaverine.tw.
106. pentaerythritol tetranitrate.tw.
107. pentoxifylline.tw.
108. phenoxybenzamine.tw.
109. pinacidil.tw.
110. pindolol.tw.
111. Pituitary Adenylate Cyclase‐Activating Polypeptide.tw.
112. prenylamine.tw.
113. propranolol.tw.
114. S‐Nitroso‐N‐Acetylpenicillamine.tw.
115. S‐Nitrosoglutathione.tw.
116. S‐Nitrosothiols.tw.
117. Suloctidil.tw.
118. Theobromine.tw.
119. Tolazoline.tw.
120. Trapidil.tw.
121. Vasoactive Intestinal Peptide.tw.
122. Verapamil.tw.
123. Vincamine.tw.
124. Xanthinol Niacinate.tw.
125. or/45‐124
126. exp Platelet Aggregation Inhibitors/
127. Epoprostenol.tw.
128. Ketanserin.tw.
129. or/126‐128
130. Phosphodiesterase Inhibitors/
131. ((phosphodiesterase2 or phosphodiesterase‐2 or phosphodiesteraseII or phosphodiesterase‐II) adj (antagonist* or inhibitor*)).tw.
132. antiphosphodiesterase*.tw.
133. Caffeine.tw.
134. calcium sensitiser*.tw.
135. Levosimendan.tw.
136. or/130‐135
137. tilarginine.tw.
138. 12 or 44 or 125 or 129 or 136 or 137
139. 6 and 138
140. randomized controlled trial.pt.
141. controlled clinical trial.pt.
142. randomized.ab.
143. placebo.ab.
144. drug therapy.fs.
145. randomly.ab.
146. trial.ab.
147. groups.ab.
148. or/140‐147
149. exp animals/ not humans.sh.
150. 148 not 149
151. 139 and 150
Embase Ovid
1. Shock, Cardiogenic/
2. cardiogenic* shock*.tw.
3. Cardiac Output, Low/
4. (low adj2 cardiac output).tw.
5. ((instab* or unstab*) adj h?emodynamic*).tw.
6. or/1‐5
7. Drug Therapy/
8. ((drug or medica* or pharmacological) adj (therap* or treatment)).tw.
9. exp Drug Administration Routes/
10. drug administ*.tw.
11. Drug Administration Schedule/
12. or/7‐11
13. exp Cardiotonic Agents/
14. cardiotonic.tw.
15. ((myocardial or cardiac) adj stimula*).tw.
16. inotrope*.tw.
17. inotropic agent*.tw.
18. cardioprotective agent*.tw.
19. acetyldigitoxin*.tw.
20. acetyldigoxin*.tw.
21. adrenomedullin.tw.
22. amrinone.tw.
23. carbachol.tw.
24. cardiac glycoside*.tw.
25. cymarine.tw.
26. deslanoside.tw.
27. digitalis glycoside*.tw.
28. digitoxin.tw.
29. digoxin.tw.
30. dobutamine.tw.
31. dopamine.tw.
32. enoximone.tw.
33. etilefrine.tw.
34. isoproterenol.tw.
35. lisinopril.tw.
36. medigoxin.tw.
37. milrinone.tw.
38. ouabain.tw.
39. oxyfedrine.tw.
40. phenylephrine.tw.
41. prenalterol.tw.
42. proscillaridin.tw.
43. strophanthin*.tw.
44. or/13‐43
45. exp Vasodilator Agents/
46. vasodilators.tw.
47. vasodilator drug*.tw.
48. vasodilator agent*.tw.
49. vasorelaxant*.tw.
50. vasoactive antagonist*.tw.
51. acetylcholine.tw.
52. adenosine*.tw.
53. adrenomedullin.tw.
54. alprostadil.tw.
55. amlodipine.tw.
56. amyl nitrite.tw.
57. bencyclane.tw.
58. bepridil.tw.
59. betahistine.tw.
60. bradykinin.tw.
61. celiprolol.tw.
62. chromonar.tw.
63. cromakalim.tw.
64. cyclandelate.tw.
65. diazoxide.tw.
66. dihydroergocristine.tw.
67. dihydroergocryptine.tw.
68. dilazep.tw.
69. diltiazem.tw.
70. dipyridamole.tw.
71. dyphylline.tw.
72. ergoloid mesylate*.tw.
73. erythrityl tetranitrate.tw.
74. felodipine.tw.
75. fenoldopam.tw.
76. flunarizine.tw.
77. hexobendine.tw.
78. hydralazine.tw.
79. iloprost.tw.
80. isosorbide dinitrate.tw.
81. isoxsuprine.tw.
82. isradipine.tw.
83. kallidin.tw.
84. lidoflazine.tw.
85. mibefradil.tw.
86. minoxidil.tw.
87. molsidomine.tw.
88. moxisylyte.tw.
89. nafronyl.tw.
90. niacin.tw.
91. nicardipine.tw.
92. nicergoline.tw.
93. nicorandil.tw.
94. nicotinyl alcohol.tw.
95. nifedipine.tw.
96. nimodipine.tw.
97. nisoldipine.tw.
98. nitrendipine.tw.
99. nitroglycerin.tw.
100. nitroprusside.tw.
101. nonachlazine.tw.
102. nylidrin.tw.
103. oxprenolol.tw.
104. oxyfedrine.tw.
105. papaverine.tw.
106. pentaerythritol tetranitrate.tw.
107. pentoxifylline.tw.
108. phenoxybenzamine.tw.
109. pinacidil.tw.
110. pindolol.tw.
111. Pituitary Adenylate Cyclase‐Activating Polypeptide.tw.
112. prenylamine.tw.
113. propranolol.tw.
114. S‐Nitroso‐N‐Acetylpenicillamine.tw.
115. S‐Nitrosoglutathione.tw.
116. S‐Nitrosothiols.tw.
117. Suloctidil.tw.
118. Theobromine.tw.
119. Tolazoline.tw.
120. Trapidil.tw.
121. Vasoactive Intestinal Peptide.tw.
122. Verapamil.tw.
123. Vincamine.tw.
124. Xanthinol Niacinate.tw.
125. or/45‐124
126. exp Platelet Aggregation Inhibitors/
127. Epoprostenol.tw.
128. Ketanserin.tw.
129. or/126‐128
130. Phosphodiesterase Inhibitors/
131. ((phosphodiesterase2 or phosphodiesterase‐2 or phosphodiesteraseII or phosphodiesterase‐II) adj (antagonist* or inhibitor*)).tw.
132. antiphosphodiesterase*.tw.
133. Caffeine.tw.
134. calcium sensitiser*.tw.
135. Levosimendan.tw.
136. or/130‐135
137. tilarginine.tw.
138. 12 or 44 or 125 or 129 or 136 or 137
139. 6 and 138
140. random$.tw.
141. factorial$.tw.
142. crossover$.tw.
143. cross over$.tw.
144. cross‐over$.tw.
145. placebo$.tw.
146. (doubl$ adj blind$).tw.
147. (singl$ adj blind$).tw.
148. assign$.tw.
149. allocat$.tw.
150. volunteer$.tw.
151. crossover procedure/
152. double blind procedure/
153. randomized controlled trial/
154. single blind procedure/
155. or/140‐154
156. (animal/ or nonhuman/) not human/
157. 155 not 156
158. 139 and 157
CPCI‐S Web of Science
#23 #22 AND #21
#22 TS=((random* or blind* or allocat* or assign* or trial* or placebo* or crossover* or cross‐over*))
#21 #20 AND #1
#20 #19 OR #18 OR #17 OR #16 OR #15 OR #14 OR #13 OR #12 OR #11 OR #10 OR #9 OR #8 OR #7 OR #6 OR #5 OR #4 OR #3 OR #2
#19 TS=( Caffeine or "calcium sensitiser*" or Levosimendan or tilarginine)
#18 TS=("phosphodiesterase2 antagonist*" or "phosphodiesterase‐2antagonist*" or "phosphodiesteraseII antagonist*" or "phosphodiesterase‐II antagonist*" or "phosphodiesterase2 inhibitor*" or "phosphodiesterase‐2 inhibitor*" or "phosphodiesteraseII inhibitor*"or "phosphodiesterase‐II inhibitor*")
#17 TS=(platelet near/2 inhibitor* or Epoprostenol or Ketanserin)
#16 TS=(Vincamine or "Xanthinol Niacinate")
#15 TS=(S‐Nitrosothiols or Sodium Azide or Suloctidil or Theobromine or Theophylline or Thiouracil or Tolazoline or Trapidil or Trimetazidine or "Vasoactive Intestinal Peptide" or Verapamil)
#14 TS=(S‐Nitrosothiols or Suloctidil or Theobromine or Tolazoline or Trapidil or "Vasoactive Intestinal Peptide" or Verapamil)
#13 TS=(S‐Nitrosothiols or Sodium Azide or Suloctidil or Theobromine or Theophylline or Thiouracil or Tolazoline or Trapidil or Trimetazidine or "Vasoactive Intestinal Peptide" or Verapamil)
#12 TS=("Pituitary Adenylate Cyclase‐Activating Polypeptide" or prenylamine or propranolol or S‐Nitrosoglutathione)
#11 TS=(nonachlazine or nylidrin or oxprenolol or oxyfedrine or papaverine or "pentaerythritol tetranitrate" or pentoxifylline or phenoxybenzamine or pinacidil or pindolol)
#10 TS=(nicorandil or "nicotinyl alcohol" or nifedipine or nimodipine or nisoldipine or nitrendipine or nitroglycerin or nitroprusside)
#9 TS=(lidoflazine or mibefradil or minoxidil or molsidomine or moxisylyte or nafronyl or niacin or nicardipine or nicergoline)
#8 TS=(fenoldopam or flunarizine or hexobendine or hydralazine or "isosorbide dinitrate" or isoxsuprine or isradipine or kallidin)
#7 TS=(dilazep or diltiazem or dipyridamole or dyphylline or "ergoloid mesylate*" or "erythrityl tetranitrate" or felodipine)
#6 TS=(celiprolol or chromonar or cromakalim or cyclandelate or diazoxide or dihydroergocristine or dihydroergocryptine)
#5 TS=(adrenomedullin or alprostadil or amlodipine or "amyl nitrite" or bencyclane or bepridil or betahistine or bradykinin)
#4 TS=(vasodilators or vasodilator drug* or vasodilator agent* or vasorelaxant* or vasoactive antagonist* or acetylcholine or adenosine*)
#3 TS=(cardiotonic or "myocardial stimula*" or "cardiac stimula*" or inotrope* or "inotropic agent*" or "cardioprotective agent*" or acetyldigitoxin* or acetyldigoxin* or adrenomedullin or amrinone or carbachol or cardiac glycoside* or cymarine or deslanoside or digitoxin or digoxin or dobutamine or enoximone or etilefrine or lisinopril or medigoxin or milrinone or ouabain or oxyfedrine or phenylephrine or prenalterol or proscillaridin or strophanthin*)
#2 TS=("drug treatment" or "medica* treatment "or "pharmacological treatment") OR TS=("drug therap*" or "medica* therap*" or "pharmacological therap*" or "drug administ*")
#1 TS=("cardiogenic* shock" OR low near/2 "cardiac output" OR "instab* h?emodynamic" or "unstab* h?emodynamic ")
Controlled trials (ISRCTN registry)
Search 1: cardiogenic shock
Search 2: low cardiac output
Centerwatch
search by Medical condition (cardiac ischemia, myocardial ischemia, heart failure) and therapeutic area (cardiogenic shock, low cardiac output)
Clinicaltrials.gov
Search 1: Conditions: cardiogenic shock
Search 2: Conditions: low cardiac output
ICTRP
Search 1:
Condition: cardiogenic shock or low cardiac output
AND
Intervention: acetyldigitoxin or acetyldigoxin or adrenomedullin or amrinone or carbachol or cardiac gycoside or cymarine or deslanoside or digitalis glycoside or digitoxin or digoxin or dobutamine
Search 2:
Condition: cardiogenic shock or low cardiac output
AND
Intervention: enoximone or etilefrine.or isoproterenol or lisinopril or medigoxin or milrinone or ouabain or oxyfedrine or phenylephrine or prenalterol or proscillaridin or strophanthin
Search 3:
Condition: cardiogenic shock or low cardiac output
AND
Intervention: acetylcholine or adenosine or adrenomedullin or alprostadil or amlodipine or amyl nitrite or bencyclane or bepridil or betahistine or bradykinin or celiprolol or chromonar or cromakalim or cyclandelate or diazoxide or dihydroergocristine
Search 4:
Condition: cardiogenic shock or low cardiac output
AND
Intervention: dihydroergocryptine or dilazep or diltiazem or dipyridamole or dyphylline or ergoloid mesylate or erythrityl tetranitrate or felodipine or fenoldopam or flunarizine or hexobendine or hydralazine iloprost or isosorbide dinitrate or isoxsuprine or isradipine
Search 5:
Condition: cardiogenic shock or low cardiac output
AND
Intervention: kallidin or lidoflazine or mibefradil or minoxidil or molsidomine or moxisylyte or nafronyl or niacin or nicardipine or nicergoline or nicorandil or nicotinyl alcohol or nifedipine or nimodipine or nisoldipine or nitrendipine or nitroglycerin
Search 6:
Condition: cardiogenic shock or low cardiac output
AND
Intervention: nitroprusside or nonachlazine or nylidrin or oxprenolol or oxyfedrine or papaverine or pentaerythritol tetranitrate or pentoxifylline or phenoxybenzamine or pinacidil or pindolol or Pituitary Adenylate or Cyclase‐Activating Polypeptide or prenylamine
Search 7:
Condition: cardiogenic shock or low cardiac output
AND
Intervention: propranolol or S‐Nitroso‐N‐Acetylpenicillamine or S‐Nitrosoglutathione or S‐Nitrosothiols or Suloctidil or Theobromine or Tolazoline or Trapidil or Vasoactive Intestinal Peptide or Verapamil or Vincamine or Xanthinol Niacinate
Search 8:
Condition: cardiogenic shock or low cardiac output
AND
Intervention: Epoprostenol or Ketanserin or Phosphodiesterase Inhibitor or phosphodiesterase2 or phosphodiesterase‐2 or phosphodiesteraseII or phosphodiesterase‐II or antiphosphodiesterase or Caffeine or calcium sensitiser or Levosimendan or tilarginine
Study flow diagram
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Comparison 1 Levosimendan versus control, Outcome 1 All‐cause short‐term mortality.
Comparison 1 Levosimendan versus control, Outcome 2 All‐cause short‐term mortality: subgroup analysis.
Comparison 1 Levosimendan versus control, Outcome 3 All‐cause long‐term mortality.
Comparison 1 Levosimendan versus control, Outcome 4 All‐cause long‐term mortality:subgroup analysis.
Comparison 1 Levosimendan versus control, Outcome 5 Cardiac index.
Comparison 1 Levosimendan versus control, Outcome 6 Pulmonary capillary wedge pressure.
Comparison 1 Levosimendan versus control, Outcome 7 Mean arterial pressure.
Comparison 2 Levosimendan versus control: sensitivity analyses, Outcome 1 All‐cause short‐term mortality: fixed‐effect model.
Comparison 2 Levosimendan versus control: sensitivity analyses, Outcome 2 All‐cause short‐term mortality: low risk of bias.
| Levosimendan compared to dobutamine for cardiogenic shock or low cardiac output syndrome | ||||||
| Patient or population: people with cardiogenic shock or low cardiac output syndrome | ||||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect | No of participants | Quality | Comments | |
| Risk with dobutamine | Risk with levosimendan | |||||
| All‐cause, short‐term mortality: range 15 days to 12 months | Moderate1 | RR 0.60 | 1776 | ⊕⊕⊝⊝ | Studies included participants with LCOS or CS due to cardiac surgery, HF or AMI | |
| 154 per 1000 | 92 per 1000 | |||||
| High2 | ||||||
| 500 per 1000 | 300 per 1000 | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Control group risk estimate comes from the median risk among the control group risk in included studies with participants with low cardiac output, low cardiac output or cardiogenic shock, or cardiogenic shock. | ||||||
| Levosimendan compared with placebo for cardiogenic shock or low cardiac output syndrome | ||||||
| Patient or population: adults with cardiogenic shock or low cardiac output syndrome Settings: hospital Intervention: levosimendan Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect | No of participants | Quality | Comments | |
| Risk with placebo | Risk with levosimendan | |||||
| All‐cause short‐term mortality: range 4 to 6 months | Moderate1 | RR 0.48 (0.12 to 1.94) | 55 | ⊕⊕⊝⊝ | Studies included participants with LCOS or CS due to HF or AMI | |
| 187 per 1000 | 90 per 1000 | |||||
| High2 | ||||||
| 500 per 1000 | 240 per 1000 | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Control group risk estimate comes from median risk among the control group risk in included studies with low cardiac output or cardiogenic shock. | ||||||
| Levosimendan compared with enoximone for cardiogenic shock | ||||||
| Patient or population: adults with cardiogenic shock Settings: hospital Intervention: levosimendan Comparison: enoximone | ||||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect | No of participants | Quality | Comments | |
| Risk with enoximone | Risk with levosimendan | |||||
| All‐cause short‐term mortality: 30 days | 625 per 10001 | 313 per 1000 (138 to 712) | RR 0.50 (0.22 to 1.14) | 32 | ⊕⊝⊝⊝ very low2,3 | Study included participants with CS due to AMI |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Control group risk estimate comes from the control group risk in a small included study with low cardiac output or cardiogenic shock. | ||||||
| Epinephrine compared with norepinephrine‐dobutamine for low cardiac output syndrome | ||||||
| Patient or population: adults with low cardiac output syndrome Setting: in‐hospital Intervention: epinephrine Comparison: norepinephrine‐dobutamine | ||||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect | No of participants | Quality | Comments | |
| Risk with norepinephrine‐dobutamine | Risk with epinephrine | |||||
| All‐cause short‐term mortality: 28 days | 267 per 1000 | 333 per 1000 | RR 1.25 (0.41 to 3.77) | 30 | ⊕⊝⊝⊝ very low1,2 | Study included participants with LCOS due to HF |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Downgraded two steps for imprecision due to few events, and the confidence interval crosses the line of no difference and includes possible benefit from both approaches. | ||||||
| Amrinone compared with dobutamine for low cardiac output syndrome | ||||||
| Patient or population: adults with low cardiac output syndrome Setting: hospital Intervention: amrinone Comparison: dobutamine | ||||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect | No of participants | Quality | Comments | |
| Risk with dobutamine | Risk with amrinone | |||||
| All‐cause short‐term mortality: 30 days | 200 per 10001 | 66 per 1000 | RR 0.33 (0.04 to 2.85) | 30 | ⊕⊝⊝⊝ very low2,3 | Study included participants with LCOS following cardiac surgery |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Control group risk estimate comes from the control group risk in participants with low cardiac output and no cardiogenic shock in the included small study. | ||||||
| Dopexamine compared with dopamine for cardiogenic shock or low cardiac output syndrome | ||||||
| Patient or population: adults with cardiogenic shock or low cardiac output syndrome Setting: hospital Intervention: dopexamine Comparison: dopamine | ||||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect | No of participants | Quality | Comments | |
| Risk with dopexamine | Risk with dopamine | |||||
| All‐cause short‐term mortality: time in hospital | 500 per 10001 | Not estimable2 | RR not estimable2 | 70 | ⊕⊝⊝⊝ very low3,4 | Study included participants with LCOS/CS following elective surgery for CABG |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Control group risk estimate comes from a large observational study, due to the small size of included studies in this population (Singh 2007). | ||||||
| Enoximone compared with dobutamine for low cardiac output syndrome | ||||||
| Patient or population: adults with low cardiac output syndrome Setting: hospital Intervention: enoximone Comparison: dobutamine | ||||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect | No of participants | Quality | Comments | |
| Risk with dobutamine | Risk with enoximone | |||||
| All‐cause short‐term mortality: 1 month | 500 per 10001 | Not estimable2 | RR not estimable2 | 40 | ⊕⊝⊝⊝ very low3,4 | Study included participants with LCOS after mitral valve surgery |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Control group risk estimate comes from a large observational study, due to the small size of included studies in this population (Singh 2007). | ||||||
| Nitric oxide compared with placebo for cardiogenic shock | ||||||
| Patient or population: adults with cardiogenic shock Setting: in‐hospital Intervention: nitric oxide Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect | No of participants | Quality | Comments | |
| Risk with nitric oxide | Risk with placebo | |||||
| All‐cause short‐term mortality: 1 month | 500 per 10001 | Not estimable2 | RR not estimable2 | 3 | ⊕⊝⊝⊝ | Study included participants with CS due to AMI |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Control group risk estimate comes from a large observational study, due to the small size of included studies in this population (Singh 2007). | ||||||
| Comparison | Primary studies | MACE | Intervention | Control | RR (95% CI) | ||
| events | total | events | total | ||||
| Levosimendan vs dobutamine | Perioperative infarction | 1 (1.4%) | 69 | 8 (11.8%) | 68 | 0.12 (0.02 to 0.96) | |
| Re‐infarction | 0 (0%) | 11 | 0 (0%) | 11 | Not estimable | ||
| Cerebrovascular accidents | 2 (2.9%) | 69 | 6 (8.8%) | 68 | 0.33 (0.07 to 1.57) | ||
| Cerebrovascular accidents | 0 (0%) | 11 | 0 (0%) | 11 | Not estimable | ||
| Levosimendan vs placebo | MACE (death, non‐fatal myocardial infarction, revascularisation of the infarct‐related artery) | 2 (50.0%) | 4 | 2 (40.0%) | 5 | 1.25 (0.29 to 5.35) | |
| Repeat PCI | 1 (25.0%) | 4 | 0 (0%) | 5 | 3.60 (0.18 to 70.34) | ||
| Amrinone vs dobutamine | Re‐infarction (2 h) | 0 (0%) | 15 | 6 (40.0%) | 15 | 0.08 (0.00 to 1.25) | |
| Dopexamine vs dopamine | Perioperative infarction | 3 (8.6%) | 35 | 2 (5.7%) | 35 | 1.50 (0.27 to 8.43) | |
| Nitric oxide vs placebo | Myocardial infarction | 1 (50.0%) | 2 | 1 (100%) | 1 | 0.67 (0.17 to 2.67) | |
| CI: confidence interval; PCI: percutaneous coronary intervention; RR: risk ratio | |||||||
| Comparison | Primary studies | Reported information | Intervention | Control | ||
| Events/time | Total | Events/time | Total | |||
| Levosimendan vs dobutamine | Stay in ICU (hours, median with IQR) | 66 (58‐74) | 69 | 158 (106‐182) | 68 | |
| Levosimendan vs enoximone | Stay in ICU (days, median with IQR) | 10 (5‐23) | 16 | 13 (7‐19) | 16 | |
| Enoximone vs dobutamine | Stay in ICU (hours, mean) | 92 ± 37 | 18 | 155 ± 129 | 19 | |
| ICU: intensive care unit; IQR: intra‐quartile‐range | ||||||
| Comparison | Primary studies | Haemodynamics | Intervention | Control | MD (95% CI) | ||
| Intervention vs control | last measurements | mean ± SD or median (IQR) | total | mean ± SD or median (IQR) | total | ||
| Levosimendan vs dobutamine | Cardiac index (after 72 h, L/min/m2) | 1.9 ± 0.1 | 23 | 1.8 ± 0.04 | 23 | 0.10 (0.06 to 0.14) | |
| Cardiac index (after 48 h, L/min/m2) | 2.8 ± 0.3 | 21 | 2.3 ± 0.2 | 20 | 0.50 (0.34 to 0.66) | ||
| Cardiac index (after 30 h, L/min/m2) | 2.9 ± 0.4 | 11 | 2.4 ± 0.2 | 11 | 0.50 (0.24 to 0.76) | ||
| Cardiac index (after 48 hrs, L/min/m2) | 3.4 ± 0.2 | 69 | 2.7 ± 0.1 | 68 | 0.70 (0.65 to 0.75) | ||
| PCWP (after 72 h, mmHg) | 19.0 ± 1 | 23 | 23.0 ± 1.0 | 23 | ‐4.00 (‐4.60 to ‐3.40) | ||
| MAP (after 48 h, mmHg) | 77.0 ± 5 | 21 | 81.0 ± 7.0 | 20 | ‐4.00 (‐7.70 to ‐0.30) | ||
| MAP (after 48 h, mmHg) | 78.8 ± 7 | 69 | 80.1 ± 4 | 68 | ‐1.30 (‐3.20 to 0.60) | ||
| Levosimendan vs placebo | Cardiac index (after 72 h, (L/min/m2) | 1.9 ± 0.1 | 23 | 1.8 ± 0.1 | 23 | 0.10 (0.04 to 0.16) | |
| PCWP (after 72 h, mmHg) | 19.0 ± 1 | 23 | 23.0 ± 1.0 | 23 | ‐4.00 (‐4.60 to ‐3.40) | ||
| Levosimendan vs enoximone | Cardiac index (after 48 h, L/min/m2) | 3.1 (2.5‐3.5) | 16 | 3.1 (2.8‐3.3) | 16 | Not estimable | |
| MAP (after 48 h (mmHg) | 75.0 (58.0‐79.0) | 16 | 70.0 (63.0‐83.0) | 16 | Not estimable | ||
| Epinephrine vs norepinephrine‐dobutamine | Cardiac index (after 24 h, L/min/m2) | 2.9 ± 0.5 | 15 | 2.8 ± 0.4 | 15 | 0.10 (‐0.22 to 0.42) | |
| MAP (after 24 h, mmHg) | 64 ± 9 | 15 | 65.0 ± 11.0 | 15 | ‐1.00 (‐8.20 to 6.20) | ||
| Dopexamine vs dopamine | Cardiac index (after 6 h, L/min/m2) | 3.1 ± 0.7 | 29 | 2.8 ± 0.5 | 30 | 0.30 (‐0.01 to 0.61) | |
| PCWP (after 6 h, mmHg) | 9.3 ± 3.2 | 29 | 10.8 ± 2.9 | 30 | ‐1.50 (‐3.10 to 0.10) | ||
| MAP (after 6 h, mmHg) | 76.3 ± 11.5 | 29 | 78.2 ± 12.8 | 30 | ‐1.90 (‐8.10 to 4.30) | ||
| CI: confidence interval; IQR: intra‐quartile‐range; MAP: mean arterial pressure; MD: mean difference; PCWP: pulmonary capillary wedge pressure; SD: standard deviation | |||||||
| Comparison | Primary studies | Adverse events (no MACE) | Intervention | Control | ||
| events | total | events | total | |||
| Levosimendan vsdobutamine | Atrial fibrillation | 78 (10.4%) | 750 | 71 (9.5%) | 748 | |
| Ventricular fibrillation | 15 (2.3%) | 660 | 19 (2.9%) | 660 | ||
| Ventricular arrhythmias | 7 (3.6%) | 193 | 25 (13.3%) | 188 | ||
| Ventricular tachycardia | 52 (7.9%) | 660 | 48 (7.3%) | 660 | ||
| Ventricular extrasystoles | 40 (6.1%) | 660 | 24 (3.6%) | 660 | ||
| Tachycardia | 33 (5.0%) | 660 | 33 (5.0%) | 660 | ||
| Bradycardia | 8 (1.2%) | 660 | 17 (2.6%) | 660 | ||
| Headache | 69 (9.0%) | 763 | 36 (4.7%) | 760 | ||
| Cardiac failure | 91 (11.9%) | 763 | 127 (16.7%) | 760 | ||
| Congestive cardiac failure | 26 (3.9%) | 660 | 22 (3.3%) | 660 | ||
| Cardiac arrest | 20 (3.0%) | 660 | 26 (3.9%) | 660 | ||
| Disorder aggravated | 17 (2,2%) | 763 | 27 (3.6%) | 760 | ||
| Gastrointestinal disorders | 54 (7.1%) | 763 | 52 (6.8%) | 760 | ||
| Acute kidney failure | 29 (4.0%) | 729 | 43 (5.9%) | 728 | ||
| Need for dialysis | 2 (2.9%) | 69 | 8 (11.9%) | 68 | ||
| Pneumonia | 34 (4.7%) | 729 | 34 (4.7%) | 728 | ||
| Multiple organ failure | 0 (0%) | 11 | 0 (0%) | 11 | ||
| Stroke | 0 (0%) | 11 | 0 (0%) | 11 | ||
| Vasoplegia | 1 (1.4 %) | 69 | 9 (13.2%) | 68 | ||
| Dyspnoea | 1 (1.4%) | 69 | 4 (5.8%) | 68 | ||
| Inflammatory response syndrome | 4 (5.8%) | 69 | 15 (22.1%) | 68 | ||
| Sepsis | 1 (1.4%) | 69 | 9 (13.2%) | 68 | ||
| Prolonged ventilatory assistance | 6 (8.7%) | 69 | 22 (32.3%) | 68 | ||
| Hypokalaemia | 62 (9.4%) | 660 | 39 (5.9%) | 660 | ||
| Hyperkalaemia | 15 (2.3%) | 660 | 16 (2.4%) | 660 | ||
| Hypotension | 102 (15.5%) | 660 | 92 (13.9%) | 660 | ||
| Nausea | 45 (6.8%) | 660 | 49 (7.4%) | 660 | ||
| Insomnia | 37 (5.6%) | 660 | 29 (4.4%) | 660 | ||
| Chest pain | 32 (4.8%) | 660 | 47 (7.1%) | 660 | ||
| Constipation | 26 (3.9%) | 660 | 28 (4.2%) | 660 | ||
| Pyrexia | 22 (3.3%) | 660 | 19 (2.9%) | 660 | ||
| Urinary tract infection | 21 (3.2%) | 660 | 30 (4.5%) | 660 | ||
| Anexiety | 20 (3.0%) | 660 | 19 (2.9%) | 660 | ||
| Pulmonary oedema | 20 (3.0%) | 660 | 18 (2.7%) | 660 | ||
| Dizziness | 19 (2.9%) | 660 | 16 (2.4%) | 660 | ||
| Cough | 19 (2.9%) | 660 | 21 (3.2%) | 660 | ||
| Pain in extremity | 18 (2.7%) | 660 | 10 (1.5%) | 660 | ||
| Pruritus | 16 (2.4%) | 660 | 7 (1.1%) | 660 | ||
| Anaemia | 15 (2.3%) | 660 | 17 (2.6%) | 660 | ||
| Epistaxis | 14 (2.1%) | 660 | 7 (1.1%) | 660 | ||
| Back pain | 13 (2.0%) | 660 | 18 (2.7%) | 660 | ||
| Angina pectoris | 12 (1.8%) | 660 | 18 (2.7%) | 660 | ||
| Muscle spasms | 12 (1.8%) | 660 | 13 (2.0%) | 660 | ||
| Dyspnoea | 9 (1.4%) | 660 | 17 (2.6%) | 660 | ||
| Hypertension | 9 (1.4%) | 660 | 15 (2.3%) | 660 | ||
| Cataract | 7 (1.1%) | 660 | 14 (2.1%) | 660 | ||
| Agitation | 7 (1.1%) | 660 | 0 (0%) | 660 | ||
| Levosimendan vsplacebo | Non‐sustained ventricular tachycardia | 1 (25.0%) | 4 | 3 (60.0%) | 5 | |
| Atrial fibrillation | 1 (25.0%) | 4 | 0 (0%) | 5 | ||
| Episodes of hypotension during drug infusion (MAP fall > 10 mmHg) | 2 (50.0%) | 4 | 1 (20.0%) | 5 | ||
| Levosimendan vsenoximone | Need of mechanical ventilation | 13 (81.3%) | 16 | 15 (93.8%) | 16 | |
| Acute renal failure | 5 (31.3%) | 16 | 8 (50.0%) | 16 | ||
| Need of continuous renal replacement therapy | 5 (31.5%) | 16 | 8 (50.0%) | 16 | ||
| New onset atrial fibrillation | 7 (43.8%) | 16 | 9 (56.3%) | 16 | ||
| Ventricular tachycardia or fibrillation | 8 (50.0%) | 16 | 11 (68.8%) | 16 | ||
| Development of systemic inflammatory response | 8 (50.0%) | 16 | 13 (81.3%) | 16 | ||
| Pneumonia | 7 (43.8%) | 16 | 7 (43.8%) | 16 | ||
| Urinary infections | 0 (0%) | 16 | 2 (12.5%) | 16 | ||
| Sepsis | 3 (18.8%) | 16 | 2 (12.5%) | 16 | ||
| Epinephrine vs. norepinephrine‐dobutamine | Supraventricular arrhythmia | 2 (13.3%) | 15 | 0 (0%) | 15 | |
| Sustained ventricular tachycardia | 1 (6.7%) | 15 | 0 (0%) | 15 | ||
| Amrinone vs. dobutamine | Cardiac arrhythmias during treatment | 0 (0%) | 15 | 4 (26.7%) | 15 | |
| Myocardial ischemias (within 16 to 20 hrs) | 4 (26.7%) | 15 | 4 (26.7%) | 15 | ||
| Dopexamine vs. dopamine | Cardiac events | 19 (54.3%) | 35 | 22 (62.9%) | 35 | |
| Abnormal blood loss | 2 (5.7%) | 35 | 1 (2.9%) | 35 | ||
| Kidney failure | 1 (2.9%) | 35 | 1 (2.9%) | 35 | ||
| Other adverse events | 5 (14.3%) | 35 | 1 (2.9%) | 35 | ||
| Major adverse events | 0 (0%) | 35 | 0 (0%) | 35 | ||
| MACE: major adverse cardiac events; MAP: mean arterial pressure | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 All‐cause short‐term mortality Show forest plot | 8 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 1.1 Levosimendan versus dobutamine | 6 | 1776 | Risk Ratio (M‐H, Random, 95% CI) | 0.60 [0.37, 0.95] |
| 1.2 Levosimendan versus placebo | 2 | 55 | Risk Ratio (M‐H, Random, 95% CI) | 0.48 [0.12, 1.94] |
| 1.3 Levosimendan versus enoximone | 1 | 32 | Risk Ratio (M‐H, Random, 95% CI) | 0.5 [0.22, 1.14] |
| 2 All‐cause short‐term mortality: subgroup analysis Show forest plot | 6 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 2.1 Levosimendan versus dobutamine: males | 1 | 956 | Risk Ratio (M‐H, Random, 95% CI) | 0.91 [0.65, 1.27] |
| 2.2 Levosimendan versus dobutamine: females | 1 | 371 | Risk Ratio (M‐H, Random, 95% CI) | 0.78 [0.46, 1.32] |
| 2.3 Levosimendan versus dobutamine: age < 65 years | 1 | 501 | Risk Ratio (M‐H, Random, 95% CI) | 1.01 [0.57, 1.81] |
| 2.4 Levosimendan versus dobutamine: age ≥ 65 years | 1 | 826 | Risk Ratio (M‐H, Random, 95% CI) | 0.80 [0.58, 1.10] |
| 2.5 Levosimendan versus dobutamine: LCOS due to HF | 3 | 1576 | Risk Ratio (M‐H, Random, 95% CI) | 0.69 [0.42, 1.11] |
| 2.6 Levosimendan versus dobutamine: LCOS due to cardiac surgery | 2 | 178 | Risk Ratio (M‐H, Random, 95% CI) | 0.38 [0.17, 0.87] |
| 2.7 Levosimendan versus placebo: LCOS due to HF | 1 | 46 | Risk Ratio (M‐H, Random, 95% CI) | 0.5 [0.10, 2.47] |
| 2.8 Levosimendan versus placebo: CS due to AMI | 1 | 9 | Risk Ratio (M‐H, Random, 95% CI) | 0.4 [0.02, 7.82] |
| 2.9 Levosimendan versus dobutamine: LCOS with no history of CHF | 1 | 156 | Risk Ratio (M‐H, Random, 95% CI) | 1.54 [0.82, 2.87] |
| 2.10 Levosimendan versus dobutamine: LCOS with history of CHF | 1 | 1171 | Risk Ratio (M‐H, Random, 95% CI) | 0.76 [0.55, 1.04] |
| 3 All‐cause long‐term mortality Show forest plot | 4 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 3.1 Levosimendan versus dobutamine | 3 | 1552 | Risk Ratio (M‐H, Random, 95% CI) | 0.85 [0.65, 1.12] |
| 3.2 Levosimendane versus dobutamine | 1 | 22 | Risk Ratio (M‐H, Random, 95% CI) | 3.0 [0.37, 24.58] |
| 3.3 Levosimendan versus placebo | 1 | 9 | Risk Ratio (M‐H, Random, 95% CI) | 0.63 [0.08, 4.66] |
| 4 All‐cause long‐term mortality:subgroup analysis Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 4.1 Levosimendan versus dobutamine: males | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 4.2 Levosimendan versus dobutamine: females | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 4.3 Levosimendan versus dobutamine: age < 65 years | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 4.4 Levosimendan versus dobutamine: age ≥ 65 years | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 5 Cardiac index Show forest plot | 6 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 5.1 Levosimendan versus dobutamine | 4 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 5.2 Levosimendan versus placebo | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 5.3 Epinephrine versus norepinephrine‐dobutamine | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 5.4 Dopexamine versus dopamine | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 6 Pulmonary capillary wedge pressure Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 6.1 Levosimendan versus dobutamine | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 6.2 Levosimendan versus placebo | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 6.3 Dopexamine versus dopamine | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 7 Mean arterial pressure Show forest plot | 4 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 7.1 Levosimendan versus dobutamine | 2 | 178 | Mean Difference (IV, Random, 95% CI) | ‐2.15 [‐4.61, 0.31] |
| 7.2 Epinephrine versus norepinephrine‐dobutamine | 1 | 30 | Mean Difference (IV, Random, 95% CI) | ‐1.0 [‐8.19, 6.19] |
| 7.3 Dopexamine versus dopamine | 1 | 59 | Mean Difference (IV, Random, 95% CI) | ‐1.90 [‐8.10, 4.30] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 All‐cause short‐term mortality: fixed‐effect model Show forest plot | 7 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.1 Levosimendan versus dobutamine | 6 | 1776 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.73 [0.57, 0.93] |
| 1.2 Levosimendan versus placebo | 2 | 55 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.47 [0.12, 1.93] |
| 2 All‐cause short‐term mortality: low risk of bias Show forest plot | 2 | 1530 | Risk Ratio (M‐H, Random, 95% CI) | 0.70 [0.39, 1.27] |
