Milrinone vs Dobutamine

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Have you found CV surgeons or cardiologists to prefer one over the other in your facilities? If so, why?

Specializes in Critical care.
Dobutamine is less arrythamogenic (sp?) than primacor.

It seems I see it the other way 'round.

Not challenging you, but in the interest of clarity, and perhaps a learning experience for one of us, care to site your source for that comparison?:an!:

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It seems I see it the other way 'round.

Not challenging you, but in the interest of clarity, and perhaps a learning experience for one of us, care to site your source for that comparison?:an!:

Our CV surgeons.. all 10 of them. Sorry no lit references.

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If the patient needs to sit on an inotrope for a few days, our CV surgeons almost always prefer Dobutamine 2.5 mcg /5 mcg (not to titrate). Dobutamine is less arrythamogenic (sp?) than primacor.

Interesting...our CV surgeons have always said the opposite (that Dobutamine is more likely to cause tachyarrythmias than Milrinone). Milrinone isn't used very often in my SICU, but when it it it's usually because the pt has pulm HTN and can't afford the increase in myocardial O2 consumption. Just my experience, seems like maybe it is just physician preference.

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Interesting...our CV surgeons have always said the opposite (that Dobutamine is more likely to cause tachyarrythmias than Milrinone). Milrinone isn't used very often in my SICU, but when it it it's usually because the pt has pulm HTN and can't afford the increase in myocardial O2 consumption. Just my experience, seems like maybe it is just physician preference.

you're probably right, just physician preference.

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Specializes in Critical care.
Our CV surgeons.. all 10 of them. Sorry no lit references.

My docs are where I too, learned it.

Funny how far evidence-based practice is yet to come, even in a 'numbers game' like CV, huh?

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Specializes in Critical Care Baby!!!!!.

where i first learned cvicu nursing primacor was the drug of choice. it worked great! however, it could cause some hypotension so you need to be careful when using it. the last few years, in a different hospital, dobutamine was the drug of choice. i totally agree with my colleagues when they say it is doc preference.

i have seen both drugs cause arrythmias. i think the most important thing to keep in mind with both of these drugs is that every patient is different. i had a patient one time that was on dobutamine and was having all sorts of ectopy and runs of what appeared to afib and then vtach. the patient needed and inotrope to keep the ci >2.0 so they switched the patient to primacor and abracadabra the ectopy was gone! best advice i can give....watch your patient everyone reacts differently!

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Specializes in Open Heart.
Any experiences with using both at the same time? Last night, I had a heart - I had levo, epi, vaso, milrinone running. And near my end of my shift, we added dob because we still couldn't couldn't get the CI >2.

This may be an obvious question, but what was the patient's fluid status? It seems that a patient on all those drips who still can't achieve a CI of >2 may require higher filling pressures in order a improve their output.

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Specializes in cardiac intensive care.

Which one is used is based on renal function and should be used that way. Milrinone should never be used on someone with a creatinine > 2.5. It has a long half life and if not excreted by the kidneys can cause severe hypotension and right sided heart failure. Dobutamine is more of a quick fix and not used for longterm as much as milrinone is. We use dobutamine for those in cardiogenic shock with severe LV dysfunction and multisystem organ involvement. Some people cannot tolerate dobut as it causes alot with ICM to have vtach and atrial dysrhythmias. People that are inotrope dependent and are being placed on the transplant list usually are started on milrinone and sent home with that.

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Specializes in CTICU.

I see milrinone used much more often on our very sick CTICU patients. Beyond that, we have a low threshold for inserting IABPs and VADs - the patient nurseABC mentioned who could not get a CI >2 would have received a balloon pump well before then in my institution.

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