Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock
© 2022. Springer-Verlag GmbH Germany, part of Springer Nature..
PURPOSE: Whether epinephrine or norepinephrine is preferable as the continuous intravenous vasopressor used to treat post-resuscitation shock is unclear. We assessed outcomes of patients with post-resuscitation shock after out-of-hospital cardiac arrest according to whether the continuous intravenous vasopressor used was epinephrine or norepinephrine.
METHODS: We conducted an observational multicenter study of consecutive patients managed in 2011-2018 for post-resuscitation shock. The primary outcome was all-cause hospital mortality, and secondary outcomes were cardiovascular hospital mortality and unfavorable neurological outcome (Cerebral Performance Category 3-5). A multivariate regression analysis and a propensity score analysis were performed, as well as several sensitivity analyses.
RESULTS: Of the 766 patients included in five hospitals, 285 (37%) received epinephrine and 481 (63%) norepinephrine. All-cause hospital mortality was significantly higher in the epinephrine group (OR 2.6; 95%CI 1.4-4.7; P = 0.002). Cardiovascular hospital mortality was also higher with epinephrine (aOR 5.5; 95%CI 3.0-10.3; P < 0.001), as was the proportion of patients with CPC of 3-5 at hospital discharge. Sensitivity analyses produced consistent results. The analysis involving adjustment on a propensity score to control for confounders showed similar findings (aOR 2.1; 95%CI 1.1-4.0; P = 0.02).
CONCLUSION: Among patients with post-resuscitation shock after out-of-hospital cardiac arrest, use of epinephrine was associated with higher all-cause and cardiovascular-specific mortality, compared with norepinephrine infusion. Until additional data become available, intensivists may want to choose norepinephrine rather than epinephrine for the treatment of post-resuscitation shock after OHCA.
| Errataetall: |
CommentIn: Ann Emerg Med. 2022 Sep;80(3):280-281. - PMID 35995519 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:48 |
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| Enthalten in: |
Intensive care medicine - 48(2022), 3 vom: 01. März, Seite 300-310 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bougouin, Wulfran [VerfasserIn] |
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| Links: |
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| Themen: |
Epinephrine |
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| Anmerkungen: |
Date Completed 30.03.2022 Date Revised 14.09.2022 published: Print-Electronic CommentIn: Ann Emerg Med. 2022 Sep;80(3):280-281. - PMID 35995519 Citation Status MEDLINE |
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| doi: |
10.1007/s00134-021-06608-7 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM336621531 |
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| 500 | |a CommentIn: Ann Emerg Med. 2022 Sep;80(3):280-281. - PMID 35995519 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022. Springer-Verlag GmbH Germany, part of Springer Nature. | ||
| 520 | |a PURPOSE: Whether epinephrine or norepinephrine is preferable as the continuous intravenous vasopressor used to treat post-resuscitation shock is unclear. We assessed outcomes of patients with post-resuscitation shock after out-of-hospital cardiac arrest according to whether the continuous intravenous vasopressor used was epinephrine or norepinephrine | ||
| 520 | |a METHODS: We conducted an observational multicenter study of consecutive patients managed in 2011-2018 for post-resuscitation shock. The primary outcome was all-cause hospital mortality, and secondary outcomes were cardiovascular hospital mortality and unfavorable neurological outcome (Cerebral Performance Category 3-5). A multivariate regression analysis and a propensity score analysis were performed, as well as several sensitivity analyses | ||
| 520 | |a RESULTS: Of the 766 patients included in five hospitals, 285 (37%) received epinephrine and 481 (63%) norepinephrine. All-cause hospital mortality was significantly higher in the epinephrine group (OR 2.6; 95%CI 1.4-4.7; P = 0.002). Cardiovascular hospital mortality was also higher with epinephrine (aOR 5.5; 95%CI 3.0-10.3; P < 0.001), as was the proportion of patients with CPC of 3-5 at hospital discharge. Sensitivity analyses produced consistent results. The analysis involving adjustment on a propensity score to control for confounders showed similar findings (aOR 2.1; 95%CI 1.1-4.0; P = 0.02) | ||
| 520 | |a CONCLUSION: Among patients with post-resuscitation shock after out-of-hospital cardiac arrest, use of epinephrine was associated with higher all-cause and cardiovascular-specific mortality, compared with norepinephrine infusion. Until additional data become available, intensivists may want to choose norepinephrine rather than epinephrine for the treatment of post-resuscitation shock after OHCA | ||
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