ANDROMEDA-SHOCK 2 Trial

They're basically the three interventions, vasodilation, fluids, and cardiac contractility.

Why did you go with dibutamine, an inodilator rather than an inopressor? Or a different inodilator, like a millinone or something like that?

Well, that's a good question, but the dobutamine did not come from myocardial dysfunction.

We start with an echo.

If you see abnormal cardiac function, you will treat it.

We had no protocol for treatment of cardiac failure.

You could do whatever you wanted.

In many cases, this worked.

In the patients where they had myocardial dysfunction and did some treatment, there was an improvement.

The dobutamine comes from the very first lactate study in the Netherlands.

In the Netherlands, we started norepinephrine, glycerin, if you had microcirculatory abnormalities.

When we discussed Andromeda 1, we said, well, hardly any experience with nitroglycerin elsewhere in the world.

I don't think anywhere in the world someone would start the mean arterial pressure of 60.

But in the Netherlands, that's not very uncommon.

And so we said it would be too risky to use nitroglycerin.

And we said, what would be a drug that is safe, but has the potential to have the same effect as nitroglycerin? And we decided to use dobutamine, basically based on the studies done in Brussels.

where they looked at the effect of butamine on microcirculatory perfusion, sublingual microcirculatory perfusion, and saw that irrespective of the effect of dobutamine on cardiac output or mediatorial pressure, there was an improvement in microcirculatory perfusion.

So that's basically why we use the dobutamine test.

That's interesting.

So dobutamine is a microcirculatory intervention, not a heart intervention.

Yes.

No, the heart intervention is way before the dobutamine and the mean arterial pressure challenge because the heart intervention is the immediate start of tier two.

You do an echo, you see a problem, you treat it.

And if you correct the cardiac dysfunction, you still have abnormal capillary refill time.

You had previous hypertension, then you would do the mean arterial pressure test.

They're basically the three interventions, vasodilation, fluids, and cardiac contractility.

Why did you go with dibutamine, an inodilator rather than an inopressor? Or a different inodilator, like a millinone or something like that?

Well, that's a good question, but the dobutamine did not come from myocardial dysfunction.

We start with an echo.

If you see abnormal cardiac function, you will treat it.

We had no protocol for treatment of cardiac failure.

You could do whatever you wanted.

In many cases, this worked.

In the patients where they had myocardial dysfunction and did some treatment, there was an improvement.

The dobutamine comes from the very first lactate study in the Netherlands.

In the Netherlands, we started norepinephrine, glycerin, if you had microcirculatory abnormalities.

When we discussed Andromeda 1, we said, well, hardly any experience with nitroglycerin elsewhere in the world.

I don't think anywhere in the world someone would start the mean arterial pressure of 60.

But in the Netherlands, that's not very uncommon.

And so we said it would be too risky to use nitroglycerin.

And we said, what would be a drug that is safe, but has the potential to have the same effect as nitroglycerin? And we decided to use dobutamine, basically based on the studies done in Brussels.

where they looked at the effect of butamine on microcirculatory perfusion, sublingual microcirculatory perfusion, and saw that irrespective of the effect of dobutamine on cardiac output or mediatorial pressure, there was an improvement in microcirculatory perfusion.

So that's basically why we use the dobutamine test.

That's interesting.

So dobutamine is a microcirculatory intervention, not a heart intervention.

Yes.

No, the heart intervention is way before the dobutamine and the mean arterial pressure challenge because the heart intervention is the immediate start of tier two.

You do an echo, you see a problem, you treat it.

And if you correct the cardiac dysfunction, you still have abnormal capillary refill time.

You had previous hypertension, then you would do the mean arterial pressure test.