학술논문
Cumulative dose of epinephrine and mode of death after non-shockable out-of-hospital cardiac arrest: a registry-based study
Document Type
Report
Author
Javaudin, François; Bougouin, Wulfran; Fanet, Lucie; Diehl, Jean-Luc; Jost, Daniel; Beganton, Frankie; Empana, Jean-Philippe; Jouven, Xavier; Adnet, Frédéric; Lamhaut, Lionel; Lascarrou, Jean-Baptiste; Cariou, Alain; Dumas, Florence; Adnet, F.; Agostinucci, J. M.; Aissaoui-Balanant, N.; Algalarrondo, V.; Alla, F.; Alonso, C.; Amara, W.; Annane, D.; Antoine, C.; Aubry, P.; Azoulay, E.; Beganton, F.; Billon, C.; Bougouin, W.; Boutet, J.; Bruel, C.; Bruneval, P.; Cariou, A.; Carli, P.; Casalino, E.; Cerf, C.; Chaib, A.; Cholley, B.; Cohen, Y.; Combes, A.; Coulaud, J. M.; Crahes, M.; Da Silva, D.; Das, V.; Demoule, A.; Denjoy, I.; Deye, N.; Diehl, J. L.; Dinanian, S.; Domanski, L.; Dreyfuss, D.; Duboc, D.; Dubois-Rande, J. L.; Dumas, F.; Duranteau, J.; Empana, J. P.; Extramiana, F.; Fagon, J. Y.; Fartoukh, M.; Fieux, F.; Gabbas, M.; Gandjbakhch, E.; Geri, G.; Guidet, B.; Halimi, F.; Henry, P.; Lucet, F. Hidden; Jabre, P.; Joseph, L.; Jost, D.; Jouven, X.; Karam, N.; Kassim, H.; Lacotte, J.; Lahlou-Laforet, K.; Lamhaut, L.; Lanceleur, A.; Langeron, O.; Lavergne, T.; Lecarpentier, E.; Leenhardt, A.; Lellouche, N.; Lemiale, V.; Lemoine, F.; Linval, F.; Loeb, T.; Ludes, B.; Luyt, C. E.; Maltret, A.; Mansencal, N.; Mansouri, N.; Marijon, E.; Marty, J.; Maury, E.; Maxime, V.; Megarbane, B.; Mekontso-Dessap, A.; Mentec, H.; Mira, J. P.; Monnet, X.; Narayanan, K.; Ngoyi, N.; Perier, M. C.; Piot, O.; Pirracchio, R.; Plaisance, P.; Plaud, B.; Plu, I.; Raphalen, J. H.; Raux, M.; Revaux, F.; Ricard, J. D.; Richard, C.; Riou, B.; Roussin, F.; Santoli, F.; Schortgen, F.; Sharifzadehgan, A.; Sharshar, T.; Sideris, G.; Similowski, T.; Spaulding, C.; Teboul, J. L.; Timsit, J. F.; Tourtier, J. P.; Tuppin, P.; Ursat, C.; Varenne, O.; Vieillard-Baron, A.; Voicu, S.; Wahbi, K.; Waldmann, V.
Source
Critical Care. December 20, 2023, Vol. 27 Issue 1
Subject
Language
English
ISSN
1364-8535
Abstract
Author(s): François Javaudin[sup.1,2,14] , Wulfran Bougouin[sup.1,3,4,5] , Lucie Fanet[sup.1] , Jean-Luc Diehl[sup.6,7] , Daniel Jost[sup.1,3,8] , Frankie Beganton[sup.1,3] , Jean-Philippe Empana[sup.1,3] , Xavier Jouven[sup.1,3,9] , Frédéric Adnet[sup.1,3,10] , Lionel Lamhaut[sup.1,3,10] [...]
Background Epinephrine increases the chances of return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA), especially when the initial rhythm is non-shockable. However, this drug could also worsen the post-resuscitation syndrome (PRS). We assessed the association between epinephrine use during cardiopulmonary resuscitation (CPR) and subsequent intensive care unit (ICU) mortality in patients with ROSC after non-shockable OHCA. Methods We used data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing OHCA data located in the Greater Paris area, France) between May 2011 and December 2021. All adults with ROSC after medical, cardiac and non-cardiac causes, non-shockable OHCA admitted to an ICU were included. The mode of death in the ICU was categorized as cardiocirculatory, neurological, or other. Results Of the 2,792 patients analyzed, there were 242 (8.7%) survivors at hospital discharge, 1,004 (35.9%) deaths from cardiocirculatory causes, 1,233 (44.2%) deaths from neurological causes, and 313 (11.2%) deaths from other etiologies. The cardiocirculatory death group received more epinephrine (4.6 [+ or -] 3.8 mg versus 1.7 [+ or -] 2.8 mg, 3.2 [+ or -] 2.6 mg, and 3.5 [+ or -] 3.6 mg for survivors, neurological deaths, and other deaths, respectively; p < 0.001). The proportion of cardiocirculatory death increased linearly (R.sup.2 = 0.92, p < 0.001) with cumulative epinephrine doses during CPR (17.7% in subjects who did not receive epinephrine and 62.5% in those who received > 10 mg). In multivariable analysis, a cumulative dose of epinephrine was strongly associated with cardiocirculatory death (adjusted odds ratio of 3.45, 95% CI [2.01-5.92] for 1 mg of epinephrine; 12.28, 95% CI [7.52-20.06] for 2-5 mg; and 23.71, 95% CI [11.02-50.97] for > 5 mg; reference 0 mg; population reference: alive at hospital discharge), even after adjustment on duration of resuscitation. The other modes of death (neurological and other causes) were also associated with epinephrine use, but to a lesser extent. Conclusions In non-shockable OHCA with ROSC, the dose of epinephrine used during CPR is strongly associated with early cardiocirculatory death. Further clinical studies aimed at limiting the dose of epinephrine during CPR seem warranted. Moreover, strategies for the prevention and management of PRS should take this dose of epinephrine into consideration for future trials. Keywords: Epinephrine, Cardiac arrest, Non-shockable OHCA, Cardiocirculatory death, Post-resuscitation shock
Background Epinephrine increases the chances of return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA), especially when the initial rhythm is non-shockable. However, this drug could also worsen the post-resuscitation syndrome (PRS). We assessed the association between epinephrine use during cardiopulmonary resuscitation (CPR) and subsequent intensive care unit (ICU) mortality in patients with ROSC after non-shockable OHCA. Methods We used data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing OHCA data located in the Greater Paris area, France) between May 2011 and December 2021. All adults with ROSC after medical, cardiac and non-cardiac causes, non-shockable OHCA admitted to an ICU were included. The mode of death in the ICU was categorized as cardiocirculatory, neurological, or other. Results Of the 2,792 patients analyzed, there were 242 (8.7%) survivors at hospital discharge, 1,004 (35.9%) deaths from cardiocirculatory causes, 1,233 (44.2%) deaths from neurological causes, and 313 (11.2%) deaths from other etiologies. The cardiocirculatory death group received more epinephrine (4.6 [+ or -] 3.8 mg versus 1.7 [+ or -] 2.8 mg, 3.2 [+ or -] 2.6 mg, and 3.5 [+ or -] 3.6 mg for survivors, neurological deaths, and other deaths, respectively; p < 0.001). The proportion of cardiocirculatory death increased linearly (R.sup.2 = 0.92, p < 0.001) with cumulative epinephrine doses during CPR (17.7% in subjects who did not receive epinephrine and 62.5% in those who received > 10 mg). In multivariable analysis, a cumulative dose of epinephrine was strongly associated with cardiocirculatory death (adjusted odds ratio of 3.45, 95% CI [2.01-5.92] for 1 mg of epinephrine; 12.28, 95% CI [7.52-20.06] for 2-5 mg; and 23.71, 95% CI [11.02-50.97] for > 5 mg; reference 0 mg; population reference: alive at hospital discharge), even after adjustment on duration of resuscitation. The other modes of death (neurological and other causes) were also associated with epinephrine use, but to a lesser extent. Conclusions In non-shockable OHCA with ROSC, the dose of epinephrine used during CPR is strongly associated with early cardiocirculatory death. Further clinical studies aimed at limiting the dose of epinephrine during CPR seem warranted. Moreover, strategies for the prevention and management of PRS should take this dose of epinephrine into consideration for future trials. Keywords: Epinephrine, Cardiac arrest, Non-shockable OHCA, Cardiocirculatory death, Post-resuscitation shock