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Erschienen in: Intensive Care Medicine 3/2022

07.02.2022 | Original

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

verfasst von: Wulfran Bougouin, Kaci Slimani, Marie Renaudier, Yannick Binois, Marine Paul, Florence Dumas, Lionel Lamhaut, Thomas Loeb, Sofia Ortuno, Nicolas Deye, Sebastian Voicu, Frankie Beganton, Daniel Jost, Armand Mekontso-Dessap, Eloi Marijon, Xavier Jouven, Nadia Aissaoui, Alain Cariou, the Sudden Death Expertise Center Investigators

Erschienen in: Intensive Care Medicine | Ausgabe 3/2022

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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.
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Metadaten
Titel
Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock
verfasst von
Wulfran Bougouin
Kaci Slimani
Marie Renaudier
Yannick Binois
Marine Paul
Florence Dumas
Lionel Lamhaut
Thomas Loeb
Sofia Ortuno
Nicolas Deye
Sebastian Voicu
Frankie Beganton
Daniel Jost
Armand Mekontso-Dessap
Eloi Marijon
Xavier Jouven
Nadia Aissaoui
Alain Cariou
the Sudden Death Expertise Center Investigators
Publikationsdatum
07.02.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 3/2022
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-021-06608-7