Hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non-shockable rhythm: A post hoc analysis of a randomized controlled trial.
Cardiac arrest
Circulatory failure
Post resuscitation shock
Targeted temperature management
Journal
Resuscitation plus
ISSN: 2666-5204
Titre abrégé: Resusc Plus
Pays: Netherlands
ID NLM: 101774410
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
19
05
2022
revised:
15
06
2022
accepted:
22
06
2022
entrez:
21
7
2022
pubmed:
22
7
2022
medline:
22
7
2022
Statut:
epublish
Résumé
Patients admitted after cardiac arrest with non-shockable rhythm frequently experience hemodynamic instability. This study assessed the hemodynamic consequences of TTM in this sub population. This is a post hoc analysis of the HYPERION trial (NCT01994772), that randomized patients to either hypothermia or normothermia after non-shockable rhythm related cardiac arrest. Patients with no, moderate or severe circulatory failure were identified with cardiovascular Sequential Organ Failure Assessment at randomization. Primary outcome was the number of patients at day 7 with resolution of shock, accounting for the risk of death (competing risk analysis). Secondary endpoint included neurological outcome and death at day-90. 584 patients were included in the analysis: 195 (34%), 46 (8%) and 340 (59%) had no, moderate and severe circulatory failure, respectively. Resolution of circulatory failure at day 7 was more frequently observed in the normothermia group than in the TTM group (60% [95 %CI 54-66] versus 53% [95 %CI 46-60], Gray-test: p = 0.016). The severity of circulatory failure at randomization was associated with its less frequent resolution at day 7 accounting for the risk of death (76 % [62-86] versus 54% [49-59] for patients with moderate versus severe circulatory failure, Gray test, p < 0.001, respectively). At day 90, the proportion of patients with Cerebral Performance Category score of 1 or 2 was lower in patients presenting severe circulatory failure (p = 0.038). Circulatory failure is frequent after CA with non-shockable rhythm. Its severity at admission and TTM were associated with delayed resolution of circulatory failure.
Sections du résumé
Background
UNASSIGNED
Patients admitted after cardiac arrest with non-shockable rhythm frequently experience hemodynamic instability. This study assessed the hemodynamic consequences of TTM in this sub population.
Methods
UNASSIGNED
This is a post hoc analysis of the HYPERION trial (NCT01994772), that randomized patients to either hypothermia or normothermia after non-shockable rhythm related cardiac arrest. Patients with no, moderate or severe circulatory failure were identified with cardiovascular Sequential Organ Failure Assessment at randomization. Primary outcome was the number of patients at day 7 with resolution of shock, accounting for the risk of death (competing risk analysis). Secondary endpoint included neurological outcome and death at day-90.
Results
UNASSIGNED
584 patients were included in the analysis: 195 (34%), 46 (8%) and 340 (59%) had no, moderate and severe circulatory failure, respectively. Resolution of circulatory failure at day 7 was more frequently observed in the normothermia group than in the TTM group (60% [95 %CI 54-66] versus 53% [95 %CI 46-60], Gray-test: p = 0.016). The severity of circulatory failure at randomization was associated with its less frequent resolution at day 7 accounting for the risk of death (76 % [62-86] versus 54% [49-59] for patients with moderate versus severe circulatory failure, Gray test, p < 0.001, respectively). At day 90, the proportion of patients with Cerebral Performance Category score of 1 or 2 was lower in patients presenting severe circulatory failure (p = 0.038).
Conclusion
UNASSIGNED
Circulatory failure is frequent after CA with non-shockable rhythm. Its severity at admission and TTM were associated with delayed resolution of circulatory failure.
Identifiants
pubmed: 35860752
doi: 10.1016/j.resplu.2022.100271
pii: S2666-5204(22)00071-6
pmc: PMC9289859
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100271Informations de copyright
© 2022 The Author(s).
Références
Intensive Care Med. 2004 May;30(5):757-69
pubmed: 14767590
Crit Care Med. 2014 Sep;42(9):2083-91
pubmed: 24901606
Resuscitation. 2019 Sep;142:136-143
pubmed: 31362081
N Engl J Med. 2019 Dec 12;381(24):2327-2337
pubmed: 31577396
J Am Heart Assoc. 2020 Feb 4;9(3):e014035
pubmed: 32009525
N Engl J Med. 2021 Jun 17;384(24):2283-2294
pubmed: 34133859
Int Emerg Nurs. 2010 Jan;18(1):8-28
pubmed: 20129438
Resuscitation. 2016 Aug;105:116-22
pubmed: 27283060
Circulation. 1988 Jan;77(1):43-52
pubmed: 2826047
Eur Heart J Acute Cardiovasc Care. 2020 Jun 17;:
pubmed: 33609135
BMC Anesthesiol. 2021 Sep 8;21(1):219
pubmed: 34496748
Crit Care Med. 2015 Feb;43(2):318-27
pubmed: 25365723
Intensive Care Med. 2021 Apr;47(4):369-421
pubmed: 33765189
Shock. 2016 Aug;46(2):214-8
pubmed: 26849625
N Engl J Med. 2013 Dec 5;369(23):2197-206
pubmed: 24237006
Resuscitation. 2010 Sep;81(9):1190-6
pubmed: 20627520
Can J Anaesth. 2017 Jul;64(7):703-715
pubmed: 28497426
Ther Hypothermia Temp Manag. 2013 Dec 1;3(4):173-177
pubmed: 24380030
Crit Care Med. 1998 Nov;26(11):1793-800
pubmed: 9824069
Resuscitation. 2015 Dec;97:1-6
pubmed: 26410569
J Crit Care. 2021 Feb;61:186-190
pubmed: 33181415
Shock. 2017 Feb;47(2):236-241
pubmed: 27488087
Eur Heart J Acute Cardiovasc Care. 2020 Nov;9(4_suppl):S122-S130
pubmed: 31246109
Am J Physiol Cell Physiol. 2008 Sep;295(3):C692-700
pubmed: 18614812