Wulfran Bougouin1,2,3, Kaci Slimani1,3, Marie Renaudier1,3, Yannick Binois1,3, Marine Paul4, Florence Dumas1,3,5,6, Lionel Lamhaut1,3,5,7, Thomas Loeb8, Sofia Ortuno1,3,5,9, Nicolas Deye10, Sebastian Voicu10, Frankie Beganton1,3, Daniel Jost1,3,11, Armand Mekontso-Dessap12,13,14, Eloi Marijon1,3,5,15, Xavier Jouven1,3,5,15, Nadia Aissaoui1,3,5,9, Alain Cariou16,17,18,19. 1. Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France. 2. Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France. 3. Paris Sudden Death Expertise Center, Paris, France. 4. Intensive Care Unit, Mignot Hospital, Le Chesnay, France. 5. Université de Paris, Paris, France. 6. Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris, France. 7. Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France. 8. SAMU des Hauts-de-Seine, APHP - Université Paris-Saclay, Hôpital Raymond Poincaré, 92 380, Garches, France. 9. Medical ICU, Georges Pompidou European Hospital, AP-HP, Paris, France. 10. Medical ICU, Lariboisière Hospital, AP-HP, Paris, France. 11. Brigade de Sapeurs Pompiers de Paris (BSPP), Paris, France. 12. Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France. 13. Faculté de Santé, Université Paris Est Créteil, Groupe de recherche clinique CARMAS, 94010, Créteil, France. 14. INSERM U955, Université Paris-Est Créteil, Créteil, France. 15. Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France. 16. Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France. alain.cariou@cch.aphp.fr. 17. Paris Sudden Death Expertise Center, Paris, France. alain.cariou@cch.aphp.fr. 18. Université de Paris, Paris, France. alain.cariou@cch.aphp.fr. 19. Medical Intensive Care Unit, AP-HP, Cochin Teaching Hospital, 27 rue du Faubourg Saint-Jacques, 75014, Paris Cedex 14, France. alain.cariou@cch.aphp.fr.
Abstract
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.
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.
Authors: Clifton W Callaway; Michael W Donnino; Ericka L Fink; Romergryko G Geocadin; Eyal Golan; Karl B Kern; Marion Leary; William J Meurer; Mary Ann Peberdy; Trevonne M Thompson; Janice L Zimmerman Journal: Circulation Date: 2015-11-03 Impact factor: 29.690
Authors: Lise Witten; Ryan Gardner; Mathias J Holmberg; Sebastian Wiberg; Ari Moskowitz; Shivani Mehta; Anne V Grossestreuer; Tuyen Yankama; Michael W Donnino; Katherine M Berg Journal: Resuscitation Date: 2019-01-30 Impact factor: 5.262
Authors: Guillaume Debaty; Jose Labarere; Ralph J Frascone; Marvin A Wayne; Robert A Swor; Brian D Mahoney; Robert M Domeier; Michael L Olinger; Brian J O'Neil; Demetris Yannopoulos; Tom P Aufderheide; Keith G Lurie Journal: J Am Coll Cardiol Date: 2017-09-19 Impact factor: 24.094
Authors: Ashish R Panchal; Jason A Bartos; José G Cabañas; Michael W Donnino; Ian R Drennan; Karen G Hirsch; Peter J Kudenchuk; Michael C Kurz; Eric J Lavonas; Peter T Morley; Brian J O'Neil; Mary Ann Peberdy; Jon C Rittenberger; Amber J Rodriguez; Kelly N Sawyer; Katherine M Berg Journal: Circulation Date: 2020-10-21 Impact factor: 29.690
Authors: Katherine M Berg; Jasmeet Soar; Lars W Andersen; Bernd W Böttiger; Sofia Cacciola; Clifton W Callaway; Keith Couper; Tobias Cronberg; Sonia D'Arrigo; Charles D Deakin; Michael W Donnino; Ian R Drennan; Asger Granfeldt; Cornelia W E Hoedemaekers; Mathias J Holmberg; Cindy H Hsu; Marlijn Kamps; Szymon Musiol; Kevin J Nation; Robert W Neumar; Tonia Nicholson; Brian J O'Neil; Quentin Otto; Edison Ferreira de Paiva; Michael J A Parr; Joshua C Reynolds; Claudio Sandroni; Barnaby R Scholefield; Markus B Skrifvars; Tzong-Luen Wang; Wolfgang A Wetsch; Joyce Yeung; Peter T Morley; Laurie J Morrison; Michelle Welsford; Mary Fran Hazinski; Jerry P Nolan Journal: Circulation Date: 2020-10-21 Impact factor: 29.690
Authors: Markus B Skrifvars; Koen Ameloot; Johannes Grand; Matti Reinikainen; Johanna Hästbacka; Ville Niemelä; Christian Hassager; Jesper Kjaergaard; Anders Åneman; Marjaana Tiainen; Niklas Nielsen; Susann Ullen; Josef Dankiewicz; Markus Harboe Olsen; Caroline Kamp Jørgensen; Manoj Saxena; Janus C Jakobsen Journal: Acta Anaesthesiol Scand Date: 2022-06-09 Impact factor: 2.274