Favorable influence of dopamine on left ventricular performance in patients refractory to discontinuation of cardiopulmonary bypass.

Of 410 consecutive patients undergoing cardiopulmonary bypass, 13 (3.2%) required pressor and inotropic support beyond volume replacement with whole blood and administration of CaCl2 to discontinue bypass. In 4 patients, isoproterenol was ineffective in maintaining cardiac output and systemic arterial pressure. In 12 patients addition and/or substitution of dopamine permitted discontinuation of cardiopulmonary bypass. In 7 patients who had serial hemodynamic measurements, mean systemic arterial pressure increased by 26%; cardiac index increased by 36%; stroke volume increased by 31%; and stroke work index increased by 83% (all p less than 0.005). There were no significant changes in central venous and mean pulmonary arterial wedge pressures, heart rate, or pulmonary and peripheral vascular resistances. Eleven of the 13 patients survived. We conclude that dopamine is an effective pressor and inotropic agent in the management of left ventricular dysfunction immediately after cardiopulmonary bypass.