Is epinephrine harmful in cardiogenic shock?

Discussion cites several papers which support the impression of lactate I describe above; those citations even share some authors with this trial! But this article then goes on to discuss lactate as a monitor of tissue perfusion, so I’m at a loss for where the authors actually stand. What I do know, with reasonable certainty, is that lactate should not be the sole driver that labels patients with “refractory cardiogenic shock.” Unless the authors can provide data showing there were other factors at play, I have to throw out their argument that epinephrine caused any measurable harm in these patients with cardiogenic shock.   In summary Half of the patients in this study were placed on an infusion that is known to increase serum lactate levels and lead to poor lactate clearance; however, that doesn’t mean lactate, or epinephrine, are evil. The mechanism by which epinephrine increases serum lactate is not known to cause clinically-significant harm. In fact, lactate production may be an adaptive mechanism that aids the body in times of stress. By every other clinically-relevant marker of efficacy, epinephrine performed as well as norepinephrine in patients with cardiogenic shock (with the exception of slightly more tachycardia). Epinephrine only caused harm in this study according to the authors’ arbitrary definition of “refractory cardiogenic shock”—a diagnosis that seemed to be driven by elevated lactates and no other measurable...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Original Articles Vince DiGiulio Source Type: research