In this 5 minute bit we discuss Phenylephrine, Angiotensin II, Dobutamine and Milrinone. Please see attached evidence related to our topic:

*Just to clarify, dobutamine and milrinone can both be used for right ventricular systolic failure but there is some evidence that milrinone may provide better pulmonary vascular afterload reduction than dobutamine.  NO MILRINONE IN RENAL FAILURE.  MILRINONE IS LONG ACTING. 

*Just to clarify, Angiotensin II data was not solely tested against placebo.  The actual randomized trial had both groups on high dose norepinephrine and one group had placebo as a second agent and the other group had angiotensin II as a second agent.  The point of the trial was to demonstrate Angiotensin II efficacy in a patient that was failing high dose norepinephrine alone (or equivalent dose of another vasopressor). So the trial was not really Angiotensin II against just placebo as both groups were also on high dose catecholamine.

https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0534-9

https://www.nejm.org/doi/full/10.1056/NEJMoa1704154

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764562/

https://www.ncbi.nlm.nih.gov/books/NBK470431/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691094/

https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Treatment-of-right-heart-failure-is-there-a-solution-to-the-problem