ECMO-/ECLS

an effective regimen as this combination can reduce afterload while also
increasing myocardial contractility. Doses of dobutamine can range from 4- 20
μg/kg/minute.
Epinephrine is a classic catecholaminergic medication that increases heart
rate and blood pressure while also increasing stroke volume. Despite these
beneficial effects, epinephrine increases metabolic rate, temperature, myocardial
oxygen consumption, and systemic and pulmonary resistance. These effects
could lead to end organ dysfunction and thus only low doses of epinephrine
should be used, if at all possible. It may often be used in conjunction with other
inotropic agents. Doses can range from 0.02-0.3 μg/kg/minute.
Norepinephrine is another classic catecholamine that possesses almost
exclusive alpha-adrenergic activity that is normally secreted by the adrenal
medulla. It is effective in “warm” shock as it raises systemic vascular resistance
and diastolic blood pressure. It can also increase cardiac contractility without
significantly increasing heart rate. Doses range from 0.1- 3 μg/kg/minute.
Phenylephrine is a pure alpha-1 agonist that is used for sudden, severe
hypotension (“Tet” spells, left ventricular outflow tract obstruction). It causes
peripheral vasoconstriction that increases systolic blood pressure. However, in
doing so, it causes a reflex bradycardia. Doses range from 0.1-0.5 ug/kg/minute.
Vasopressin (antidiuretic hormone) is a normally produced by the
hypothalamus. It acts on V1 receptors on vascular smooth muscle cells to effect
vasoconstriction. Since catecholamine effects on vascular smooth muscle can be
inhibited by the activation of ATP-dependent potassium channels and nitric