Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock.
Epinephrine
Norepinephrine
Out-of-hospital cardiac arrest
Post-resuscitation shock
Vasopressor therapy
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
12
08
2021
accepted:
21
12
2021
pubmed:
8
2
2022
medline:
31
3
2022
entrez:
7
2
2022
Statut:
ppublish
Résumé
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. 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. 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). 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.
Identifiants
pubmed: 35129643
doi: 10.1007/s00134-021-06608-7
pii: 10.1007/s00134-021-06608-7
doi:
Substances chimiques
Vasoconstrictor Agents
0
Norepinephrine
X4W3ENH1CV
Epinephrine
YKH834O4BH
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
300-310Investigateurs
F Adnet
(F)
J M Agostinucci
(JM)
N Aissaoui-Balanant
(N)
V Algalarrondo
(V)
F Alla
(F)
C Alonso
(C)
W Amara
(W)
D Annane
(D)
C Antoine
(C)
P Aubry
(P)
E Azoulay
(E)
F Beganton
(F)
C Billon
(C)
W Bougouin
(W)
J Boutet
(J)
C Bruel
(C)
P Bruneval
(P)
A Cariou
(A)
P Carli
(P)
E Casalino
(E)
C Cerf
(C)
A Chaib
(A)
B Cholley
(B)
Y Cohen
(Y)
A Combes
(A)
J M Coulaud
(JM)
M Crahes
(M)
D Da Silva
(D)
V Das
(V)
A Demoule
(A)
I Denjoy
(I)
N Deye
(N)
J L Diehl
(JL)
S Dinanian
(S)
L Domanski
(L)
D Dreyfuss
(D)
D Duboc
(D)
J L Dubois-Rande
(JL)
F Dumas
(F)
J Duranteau
(J)
J P Empana
(JP)
F Extramiana
(F)
J Y Fagon
(JY)
M Fartoukh
(M)
F Fieux
(F)
M Gabbas
(M)
E Gandjbakhch
(E)
G Geri
(G)
B Guidet
(B)
F Halimi
(F)
P Henry
(P)
F Hidden Lucet
(F)
P Jabre
(P)
L Joseph
(L)
D Jost
(D)
X Jouven
(X)
N Karam
(N)
H Kassim
(H)
J Lacotte
(J)
K Lahlou-Laforet
(K)
L Lamhaut
(L)
A Lanceleur
(A)
O Langeron
(O)
T Lavergne
(T)
E Lecarpentier
(E)
A Leenhardt
(A)
N Lellouche
(N)
V Lemiale
(V)
F Lemoine
(F)
F Linval
(F)
T Loeb
(T)
B Ludes
(B)
C E Luyt
(CE)
A Maltret
(A)
N Mansencal
(N)
N Mansouri
(N)
E Marijon
(E)
J Marty
(J)
E Maury
(E)
V Maxime
(V)
B Megarbane
(B)
A Mekontso-Dessap
(A)
H Mentec
(H)
J P Mira
(JP)
X Monnet
(X)
K Narayanan
(K)
N Ngoyi
(N)
M C Perier
(MC)
O Piot
(O)
R Pirracchio
(R)
P Plaisance
(P)
B Plaud
(B)
I Plu
(I)
J H Raphalen
(JH)
M Raux
(M)
F Revaux
(F)
J D Ricard
(JD)
C Richard
(C)
B Riou
(B)
F Roussin
(F)
F Santoli
(F)
F Schortgen
(F)
A Sharifzadehgan
(A)
T Sharshar
(T)
G Sideris
(G)
T Similowski
(T)
C Spaulding
(C)
J L Teboul
(JL)
J F Timsit
(JF)
J P Tourtier
(JP)
P Tuppin
(P)
C Ursat
(C)
O Varenne
(O)
A Vieillard-Baron
(A)
S Voicu
(S)
K Wahbi
(K)
V Waldman
(V)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.
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