Observational Study

. 2022 Mar;48(3):300-310.

doi: 10.1007/s00134-021-06608-7. Epub 2022 Feb 7.

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

Wulfran Bougouin^{1

2

3}, Kaci Slimani^{1

3}, Marie Renaudier^{1

3}, Yannick Binois^{1

3}, Marine Paul⁴, Florence Dumas^{1

3

5

6}, Lionel Lamhaut^{1

3

5

7}, Thomas Loeb⁸, Sofia Ortuno^{1

3

5

9}, Nicolas Deye¹⁰, Sebastian Voicu¹⁰, Frankie Beganton^{1

3}, Daniel Jost^{1

3

11}, Armand Mekontso-Dessap^{12

13

14}, Eloi Marijon^{1

3

5

15}, Xavier Jouven^{1

3

5

15}, Nadia Aissaoui^{1

3

5

9}, Alain Cariou^{16

17

18

19}; Sudden Death Expertise Center Investigators

Collaborators, Affiliations

Collaborators

Sudden Death Expertise Center Investigators:
F Adnet, J M Agostinucci, N Aissaoui-Balanant, V Algalarrondo, F Alla, C Alonso, W Amara, D Annane, C Antoine, P Aubry, E Azoulay, F Beganton, C Billon, W Bougouin, J Boutet, C Bruel, P Bruneval, A Cariou, P Carli, E Casalino, C Cerf, A Chaib, B Cholley, Y Cohen, A Combes, J M Coulaud, M Crahes, D Da Silva, V Das, A Demoule, I Denjoy, N Deye, J L Diehl, S Dinanian, L Domanski, D Dreyfuss, D Duboc, J L Dubois-Rande, F Dumas, J Duranteau, J P Empana, F Extramiana, J Y Fagon, M Fartoukh, F Fieux, M Gabbas, E Gandjbakhch, G Geri, B Guidet, F Halimi, P Henry, F Hidden Lucet, P Jabre, L Joseph, D Jost, X Jouven, N Karam, H Kassim, J Lacotte, K Lahlou-Laforet, L Lamhaut, A Lanceleur, O Langeron, T Lavergne, E Lecarpentier, A Leenhardt, N Lellouche, V Lemiale, F Lemoine, F Linval, T Loeb, B Ludes, C E Luyt, A Maltret, N Mansencal, N Mansouri, E Marijon, J Marty, E Maury, V Maxime, B Megarbane, A Mekontso-Dessap, H Mentec, J P Mira, X Monnet, K Narayanan, N Ngoyi, M C Perier, O Piot, R Pirracchio, P Plaisance, B Plaud, I Plu, J H Raphalen, M Raux, F Revaux, J D Ricard, C Richard, B Riou, F Roussin, F Santoli, F Schortgen, A Sharifzadehgan, T Sharshar, G Sideris, T Similowski, C Spaulding, J L Teboul, J F Timsit, J P Tourtier, P Tuppin, C Ursat, O Varenne, A Vieillard-Baron, S Voicu, K Wahbi, V Waldman

Affiliations

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.

PMID: 35129643
DOI: 10.1007/s00134-021-06608-7

Observational Study

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

Wulfran Bougouin et al. Intensive Care Med. 2022 Mar.

. 2022 Mar;48(3):300-310.

doi: 10.1007/s00134-021-06608-7. Epub 2022 Feb 7.

Authors

Collaborators

Sudden Death Expertise Center Investigators:
F Adnet, J M Agostinucci, N Aissaoui-Balanant, V Algalarrondo, F Alla, C Alonso, W Amara, D Annane, C Antoine, P Aubry, E Azoulay, F Beganton, C Billon, W Bougouin, J Boutet, C Bruel, P Bruneval, A Cariou, P Carli, E Casalino, C Cerf, A Chaib, B Cholley, Y Cohen, A Combes, J M Coulaud, M Crahes, D Da Silva, V Das, A Demoule, I Denjoy, N Deye, J L Diehl, S Dinanian, L Domanski, D Dreyfuss, D Duboc, J L Dubois-Rande, F Dumas, J Duranteau, J P Empana, F Extramiana, J Y Fagon, M Fartoukh, F Fieux, M Gabbas, E Gandjbakhch, G Geri, B Guidet, F Halimi, P Henry, F Hidden Lucet, P Jabre, L Joseph, D Jost, X Jouven, N Karam, H Kassim, J Lacotte, K Lahlou-Laforet, L Lamhaut, A Lanceleur, O Langeron, T Lavergne, E Lecarpentier, A Leenhardt, N Lellouche, V Lemiale, F Lemoine, F Linval, T Loeb, B Ludes, C E Luyt, A Maltret, N Mansencal, N Mansouri, E Marijon, J Marty, E Maury, V Maxime, B Megarbane, A Mekontso-Dessap, H Mentec, J P Mira, X Monnet, K Narayanan, N Ngoyi, M C Perier, O Piot, R Pirracchio, P Plaisance, B Plaud, I Plu, J H Raphalen, M Raux, F Revaux, J D Ricard, C Richard, B Riou, F Roussin, F Santoli, F Schortgen, A Sharifzadehgan, T Sharshar, G Sideris, T Similowski, C Spaulding, J L Teboul, J F Timsit, J P Tourtier, P Tuppin, C Ursat, O Varenne, A Vieillard-Baron, S Voicu, K Wahbi, V Waldman

Affiliations

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.

PMID: 35129643
DOI: 10.1007/s00134-021-06608-7

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.

Keywords: Epinephrine; Norepinephrine; Out-of-hospital cardiac arrest; Post-resuscitation shock; Vasopressor therapy.

PubMed Disclaimer

Comment in

Epinephrine Norepinephrine, That Is the Question: September 2022 Annals of Emergency Medicine Journal Club.
Templeton M, Spiegel R. Templeton M, et al. Ann Emerg Med. 2022 Sep;80(3):280-281. doi: 10.1016/j.annemergmed.2022.07.011. Ann Emerg Med. 2022. PMID: 35995519 No abstract available.

References

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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Comment in

References

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Medical