The boundary for stopping the trial owing to the lack of evidence of a difference between treatments at a P value of 0.05 was crossed (Figure 5 in the Supplementary Appendix). There were no significant differences between the groups in the rate of death at 28 days or in the rates of death in the ICU, in the hospital, at 6 months, or at 12 months (Table 2). Kaplan–Meier curves for estimated survival showed no significant differences in the outcome (Figure 2). Cox proportional-hazards analyses that included the APACHE II score, sex, and other relevant variables yielded similar results (Figure 6 in the Supplementary Appendix). There were more days without need for the trial drug and more days without need for open-label vasopressors in the norepinephrine group than in the dopamine group, but there were no significant differences between the groups in the number of days without need for ICU care and in the number of days without need for organ support (Table 3). There were no significant differences in the causes of death between the two groups, although death from refractory shock occurred more frequently in the group of patients treated with dopamine than in the group treated with norepinephrine (P=0.05).
Among patients with cardiogenic shock, the rate of death was significantly higher in the group treated with dopamine than in the group treated with norepinephrine, although one might expect that cardiac output would be better maintained with dopamine26-28 than with norepinephrine. The exact cause of the increased mortality cannot be determined, but the early difference in the rate of death suggests that the higher heart rate with dopamine may have contributed to the occurrence of ischemic events. Whatever the mechanism may be, these data strongly challenge the current American College of Cardiology–American Heart Association guidelines, which recommend dopamine as the first-choice agent to increase arterial pressure among patients who have hypotension as a result of an acute myocardial infarction.7
The simplest method to measure an athlete's vertical jump is to get the athlete to reach up against a flat wall, with a flat surface under his/her feet (such as a gym floor or concrete) and record the highest point he/she can reach flat-footed (the height of this point from the ground is referred to as "standing reach"); fingertips powdered with chalk can facilitate the determination of points touched on the wall. The athlete then makes an effort to jump up with the goal of touching the highest point on the wall that he or she can reach; the athlete can perform these jumps as many times as needed. The height of the highest point the athlete touches is recorded. The difference between this height and the standing reach is the athlete's vertical jump.