DOREMI Trial
Details
DOREMI compared dobutamine with milrinone in patients with cardiogenic shock, addressing the common clinical choice between a β-agonist inodilator and a phosphodiesterase-3 inhibitor. It is the principal randomised evidence that neither inotrope is superior on the trial's composite endpoint. (sources/cardiogenic-shock-acc-2025, rating: very high)
Key Facts
- n = 192; SCAI stage B–E cardiogenic shock. (sources/cardiogenic-shock-acc-2025, rating: very high)
- Dobutamine vs milrinone: no difference in the primary composite endpoint. (sources/cardiogenic-shock-acc-2025, rating: very high)
- The result sits within a broader absence of mortality benefit for any inotrope or vasodilator in cardiogenic shock — a Cochrane analysis found no agent with proven mortality benefit. (sources/cardiogenic-shock-acc-2025, rating: very high)
- Milrinone is renally excreted and has a long half-life, so it is used cautiously in worsening renal function; dobutamine is the more commonly used inotrope. (sources/cardiogenic-shock-acc-2025, rating: very high)
Contradictions / Open Questions
- A neutral composite endpoint does not establish equivalence for every outcome. The trial was not powered to exclude differences in mortality, arrhythmia or duration of support, and the choice between agents remains driven by haemodynamics, renal function and clinician preference. (sources/cardiogenic-shock-acc-2025, rating: very high)
- The enrolled population spans SCAI B–E, a wide severity range; whether a specific phenotype (e.g. high SVR, renal dysfunction, RV-predominant shock) favours one agent is untested. (sources/cardiogenic-shock-acc-2025, rating: very high)
Connections
- Related to concepts/Cardiogenic-Shock — pharmacological management
- Related to concepts/Cardiogenic-Shock — inotrope and vasopressor selection
- Related to concepts/Cardiogenic-Shock — escalation when pharmacological support is insufficient