• Daniel De Backer, Arias OrtizJulianJDepartment of Intensive Care, National ECMO Center, Calderon Guardia Hospital, Universidad de Costa Rica, San José, Costa Rica., and Bruno Levy.
• Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium.
• Curr Opin Crit Care. 2021 Aug 1; 27 (4): 426-432.

Purpose Of ReviewTo discuss the use of vasopressors and inotropes in cardiogenic shock.Recent FindingsThe classic form or cardiogenic shock requires administration of inotropic and/or vasopressor agents to try to improve the impaired tissue perfusion. Among vasopressors various alpha-adrenergic agents, vasopressin derivatives and angiotensin can be used. The first-line therapy remains norepinephrine as it is associated with minimal adverse effects and appears to be associated by the best outcome in network meta-analyses. On the contrary, epinephrine is associated with an increased incidence of refractory shock and observational studies suggest an increased risk of death. Vasopressin may be an excellent alternative in tachycardiac patients or in the presence of pulmonary hypertension. Concerning inotropic agents, dobutamine is the first-line agent but levosimendan is an excellent alternative or additional agent in cases not responding to dobutamine. The impact on outcome of inotropic agents remains controversial.SummaryRecent studies have refined the position of the various vasopressor and inotropic agents. Norepinephrine is recommended as first-line vasopressor agent by various guidelines. Among inotropic agents, selection between the agents should be individualized and based on the hemodynamic response.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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