The evaluation and treatment of patients with cardiovascular shock is a cornerstone of emergency care. Unfortunately, the literature behind the use of vasoactive medications in cardiovascular shock is inconsistent. A Cochrane review in 2004 declared “the current available evidence is not suited to inform clinical practice”.

Since 2004, there has been an impressive amount of research to investigate the use and safety of pressors, including several large, multi-center clinical trials. However, the results continue to be inconsistent and conflicting.

An updated Cochrane review in 2016 concluded that, with the exception of an increased risk for arrhythmia associated with dopamine, there is no significant difference in mortality between vasopressors and “evidence of any other differences between any of the six vasopressors examined is insufficient”.

These findings reflect the underlying complexity of vasopressor use.

With that in mind, let’s delve into the literature behind each pressor, so that we can make informed decisions about which pressors are appropriate for patients in circulatory shock.

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