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Summary of the SOAP-II (De Backer 2010) Trial
Among patients with all types of shock, mortality rates were not different between norepinephrine and dopamine, although norepinephrine was more effective as a vasopressor and was less associated with arrhythmias. Norepinephrine may have a mortality benefit over dopamine in a subset of patients with cardiogenic shock.
Key Points from SOAP-II (De Backer 2010)
- Included 1679 patients requiring vasopressor support for shock despite a small fluid challenge (60% septic, 20% cardiogenic, 15% hypovolemic)
- Randomized to dopamine (titrated by 2 mcg/kg/min to max 20 mcg/kg/min) or norepinephrine (titrated by 0.02 mcg/kg/min to max 0.19 mcg/kg/min — 15 mcg/min for 80 kg patient)
- Open-label norepinephrine was allowed once blinded vasopressor reached maximum dose
- Primary endpoint (28-day mortality) was not different between the two groups (52.5% vs. 48.5%, p=0.10). ICU, hospital, 6-month, and 12-month mortality rates were also not different between groups
- Cardiogenic shock, a pre-specified subgroup, showed higher 28-day mortality with dopamine (p=0.03)
- Dopamine group required more open-label norepinephrine (26% vs. 20%, p<0.001), had higher urine output in first 24 hours (but similar overall fluid balance), and had a higher heart rate
- Arrhythmias, mostly atrial fibrillation, were more common with dopamine (24.1% vs. 12.4%, p<0.001, NNH 9)
Citation
De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010 Mar 4;362(9):779-89. PMID 20200382
