Are vasopressors useful in toxin-induced cardiogenic shock?
OBJECTIVE
Overdoses with cardio-depressive medications can result in toxin-induced cardiogenic shock (TICS), a life-threatening condition characterized by severe hypotension and ineffective tissue perfusion. Vasopressors are often employed in the treatment of shock to increase heart rate and blood pressure. We sought to conduct a systematic review of the literature to evaluate the effectiveness of vasopressors in improving hemodynamic function and survival in the treatment of TICS.


METHODS
We searched PubMed, EMBASE, TOXLINE, and International Pharmaceutical Abstracts.


METHODS
We included studies evaluating the use of vasopressors in humans or animals with TICS. We limited human study types to randomized controlled trials, clinical trials, observational studies, and case reports.


METHODS
Our search yielded 913 citations and 144 of these met our inclusion criteria. 130 were human case reports and 14 were animal studies.


RESULTS
Human case report data showed vasopressors were ineffective more often than they were partially or fully effective. In the majority of animal studies, vasopressor treatment failed to improve hemodynamic parameters and resulted in decreased survival.


CONCLUSIONS
Human case reports and controlled animal experiments lead to different conclusions about vasopressors in TICS. Most animal studies indicate that vasopressors impair hemodynamic function and increase mortality. In contrast, human case reports suggest that vasopressors are often ineffective but not necessarily harmful.
a College of Pharmacy, University of Minnesota , Minneapolis , MN , USA.
Cassandra A
CA
Skoog
b Emergency Medicine Department , Region's Hospital , St. Paul , MN , USA.
Kristin M
KM
Engebretsen
D000818:Animals; D000929:Antidepressive Agents, Tricyclic / Q000633:toxicity; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000633:toxicity*; D004195:Disease Models, Animal; D062787:Drug Overdose / Q000188:drug therapy; D005934:Glucagon / Q000627:therapeutic use; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D064887:Observational Studies as Topic; D000069348:Quetiapine Fumarate / Q000633:toxicity; D016032:Randomized Controlled Trials as Topic; D012770:Shock, Cardiogenic / Q000139:chemically induced / Q000188:drug therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000929:Antidepressive Agents, Tricyclic; D002121:Calcium Channel Blockers; D014662:Vasoconstrictor Agents; D000069348:Quetiapine Fumarate; D005934:Glucagon
Cardiogenic shock; overdose; poison-induced shock; toxicity; vasopressors