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. 2021 Dec 30;30(6):946-956.
doi: 10.5603/CJ.a2021.0173. Online ahead of print.

Association between dose of catecholamines and markers of organ injury early after out-of-hospital cardiac arrest

Katarzyna Czerwińska-Jelonkiewicz  1   2 , Alice Wood  3 , Allan Bohm  4 , Przemysław Kwasiborski  5 , Anna Oleksiak  6 , Robert Ryczek  7 , Johannes Grand  8 , Guido Tavazzi  9 , Alessandro Sionis  10 , Janina Stępińska  6
Affiliations

Association between dose of catecholamines and markers of organ injury early after out-of-hospital cardiac arrest

Katarzyna Czerwińska-Jelonkiewicz et al. Cardiol J. .

Abstract

Background: Catecholamines are recommended as first-line drugs to treat hemodynamic instability after out-of-hospital cardiac arrest (OHCA). The benefit-to-risk ratio of catecholamines is dose dependent, however, their effect on metabolism and organ function early after OHCA has not been investigated.

Methods: The Post-Cardiac Arrest Syndrome (PCAS) pilot study was a prospective, observational, multicenter study. The primary outcomes of this analysis were association between norepinephrine/cumulative catecholamines doses and neuron specific enolase (NSE)/lactate concentration over the first 72 hours after resuscitation. The association was adjusted for proven OHCA mortality predictors and verified with propensity score matching (PSM).

Results: Overall 148 consecutive OHCA patients; aged 18-91 (62.9 ± 15.27), 41 (27.7%) being female, were included. Increasing norepinephrine and cumulative catecholamines doses were significantly associated with higher NSE concentration on admission (r = 0.477, p < 0.001; r = 0.418, p < 0.001) and at 24 hours after OHCA (r = 0.339, p < 0.01; r = 0.441, p < 0.001) as well as with higher lactate concentration on admission (r = 0.404, p < 0.001; r = 0.280, p < 0.01), at 24 hours (r = 0.476, p < 0.00; r = 0.487, p < 0.001) and 48 hours (r = 0.433, p < 0.01; r = 0.318, p = 0.01) after OHCA. The associations remained significant up to 48 hours in non-survivors after PSM.

Conclusions: Increasing the dose of catecholamines is associated with higher lactate and NSE concentration, which may suggest their importance for tissue oxygen delivery, anaerobic metabolism, and organ function early after OHCA.

Keywords: cardiac arrest; catecholamines; metabolism after cardiac arrest; organ failure after cardiac arrest; out-of-hospital cardiac arrest.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
A. Association between norepinephrine dose and lactate concentration on admission in the study population; B. Association between norepinephrine dose and lactate concentration 24 hours after admission in the study population; C. Association between norepinephrine dose and lactate concentration 48 hours after admission in the study population; BP — blood pressure; ROSC — return of spontaneous circulation.
Figure 2
Figure 2
A. Association between cumulative catecholamines dose and lactate concentration on admission in the study population; B. Association between cumulative catecholamines dose and lactate concentration 24 hours after admission in the study population; C. Association between cumulative catecholamines dose and lactate concentration 48 hours after admission in study population; BP — blood pressure; ROSC — return of spontaneous circulation.
Figure 4
Figure 4
A. Association between cumulative catecholamines dose and neuronal specific enolase (NSE) concentration on admission in the study population; B. Association between cumulative catecholamines dose and NSE concentration 24 hours after admission in the study population.
Figure 3
Figure 3
A. Association between norepinephrine dose and neuronal specific enolase (NSE) concentration on admission in the study population; B. Association between norepinephrine dose and NSE concentration 24 hours after admission in the study population.
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