학술논문
Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock.
Document Type
Academic Journal
Author
Bougouin W; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France.; Paris Sudden Death Expertise Center, Paris, France.; Slimani K; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Renaudier M; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Binois Y; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Paul M; Intensive Care Unit, Mignot Hospital, Le Chesnay, France.; Dumas F; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Université de Paris, Paris, France.; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris, France.; Lamhaut L; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Université de Paris, Paris, France.; Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France.; Loeb T; SAMU des Hauts-de-Seine, APHP - Université Paris-Saclay, Hôpital Raymond Poincaré, 92 380, Garches, France.; Ortuno S; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Université de Paris, Paris, France.; Medical ICU, Georges Pompidou European Hospital, AP-HP, Paris, France.; Deye N; Medical ICU, Lariboisière Hospital, AP-HP, Paris, France.; Voicu S; Medical ICU, Lariboisière Hospital, AP-HP, Paris, France.; Beganton F; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Jost D; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Brigade de Sapeurs Pompiers de Paris (BSPP), Paris, France.; Mekontso-Dessap A; Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France.; Faculté de Santé, Université Paris Est Créteil, Groupe de recherche clinique CARMAS, 94010, Créteil, France.; INSERM U955, Université Paris-Est Créteil, Créteil, France.; Marijon E; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Université de Paris, Paris, France.; Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France.; Jouven X; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Université de Paris, Paris, France.; Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France.; Aissaoui N; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.; Paris Sudden Death Expertise Center, Paris, France.; Université de Paris, Paris, France.; Medical ICU, Georges Pompidou European Hospital, AP-HP, Paris, France.; Cariou A; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France. alain.cariou@cch.aphp.fr.; Paris Sudden Death Expertise Center, Paris, France. alain.cariou@cch.aphp.fr.; Université de Paris, Paris, France. alain.cariou@cch.aphp.fr.; 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.
Source
Publisher: Springer Verlag Country of Publication: United States NLM ID: 7704851 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1238 (Electronic) Linking ISSN: 03424642 NLM ISO Abbreviation: Intensive Care Med Subsets: MEDLINE
Subject
Language
English
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.
(© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.)
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.
(© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.)