Lancet. 2007 Aug 25;370(9588):676-84.

Erratum in:
    Lancet. 2007 Sep 22;370(9592):1034.

Annane D, Vignon P, Renault A, Bollaert PE, Charpentier C, Martin C, Troché G,
Ricard JD, Nitenberg G, Papazian L, Azoulay E, Bellissant E; CATS Study Group.

Raymond Poincaré Hospital (AP-HP), University of Versailles Saint Quentin, PRES
UniverSud, Paris, France. This email address is being protected from spambots. You need JavaScript enabled to view it.

BACKGROUND: International guidelines for management of septic shock recommend
that dopamine or norepinephrine are preferable to epinephrine. However, no large
comparative trial has yet been done. We aimed to compare the efficacy and safety
of norepinephrine plus dobutamine (whenever needed) with those of epinephrine
alone in septic shock. METHODS: This prospective, multicentre, randomised,
double-blind study was done in 330 patients with septic shock admitted to one of
19 participating intensive care units in France. Participants were assigned to
receive epinephrine (n=161) or norepinephrine plus dobutamine (n=169), which were
titrated to maintain mean blood pressure at 70 mm Hg or more. The primary outcome
was 28-day all-cause mortality. Analyses were by intention to treat. This trial
is registered with, number NCT00148278. FINDINGS: There were
no patients lost to follow-up; one patient withdrew consent after 3 days. At day
28, there were 64 (40%) deaths in the epinephrine group and 58 (34%) deaths in
the norepinephrine plus dobutamine group (p=0.31; relative risk 0.86, 95% CI
0.65-1.14). There was no significant difference between the two groups in
mortality rates at discharge from intensive care (75 [47%] deaths vs 75 [44%]
deaths, p=0.69), at hospital discharge (84 [52%] vs 82 [49%], p=0.51), and by day
90 (84 [52%] vs 85 [50%], p=0.73), time to haemodynamic success (log-rank
p=0.67), time to vasopressor withdrawal (log-rank p=0.09), and time course of
SOFA score. Rates of serious adverse events were also similar. INTERPRETATION:
There is no evidence for a difference in efficacy and safety between epinephrine
alone and norepinephrine plus dobutamine for the management of septic shock.