Levy 2011.

Methods	Single‐centre randomized controlled trial, University hospital; France
Participants	Adult participants with cardiogenic shock. Mean age 65 years, 30% female, SAP II score 51, SOFA score 8.5 acute or chronic heart failure with EF < 30% or CI < 2.2 L/min/m2 and systolic blood pressure: < 90 mm Hg; MAP < 60 mm Hg or drop in MAP > 30 mm Hg despite dobutamine up to 10 µg/kg/min and dopamine up to 20 µg/kg/min (N = 30)
Interventions	Epinephrine (mean dose 0.15 µg/kg/min at 24 hours for 5 days) vs norepinephrine (mean dose 0.13 µg/kg/min at 24 hours) + dobutamine (8 ± 2 µg/kg/min for 5 days) Target MAP between 65 and 70 mm Hg and stable CI
Outcomes	Mortality 28 days. Vasopressor titration, haemodynamic, metabolic, splanchnic and renal parameters at baseline, 1, 6, 12 and 24 hours
Notes	Before study: Start with dobutamine up to 10 µg/kg/min, then dopamine up to 2 to 20 µg/kg/min, then start study drug and concomitantly stop dopamine. Dobutamine stopped in the epinephrine group Funding: not reported Conflits of interest: none
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomization code
Allocation concealment (selection bias)	Unclear risk	Consecutive patients, …according to the randomization code
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Complete follow‐up for study period
Explicit in‐/exclusion criteria	Low risk	Described explicitly
ITT‐analysis	Low risk	Performed
Adequate patient description	Low risk	Adequately described
Identical care	Unclear risk	Open‐label intervention, no treatment protocol presented
Outcome description	Low risk	Clear
Physicians blinded	High risk	Not reported/not performed
Outcome assessors blinded?	Unclear risk	Low risk for mortality, unclear risk for other outcomes