Details

Autor(en) / Beteiligte

• Bougouin, Wulfran
• Slimani, Kaci
• Renaudier, Marie
• Binois, Yannick
• Paul, Marine
• Dumas, Florence
• Lamhaut, Lionel
• Loeb, Thomas
• Ortuno, Sofia
• Deye, Nicolas
• Voicu, Sebastian
• Beganton, Frankie
• Jost, Daniel
• Mekontso-Dessap, Armand
• Marijon, Eloi
• Jouven, Xavier
• Aissaoui, Nadia
• Cariou, Alain

Titel

Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock

Ist Teil von

• Intensive care medicine, 2022-03, Vol.48 (3), p.300-310

Ort / Verlag

Berlin/Heidelberg: Springer Berlin Heidelberg

Erscheinungsjahr

2022

Quelle

springer (창간호~2014)

Beschreibungen/Notizen

• 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.