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. 2022 Apr 6;22(1):345.
doi: 10.1186/s12879-022-07337-y.

Prehospital norepinephrine administration reduces 30-day mortality among septic shock patients

Romain Jouffroy  1   2   3   4   5 , Adèle Hajjar  6 , Basile Gilbert  7 , Jean Pierre Tourtier  8 , Emmanuel Bloch-Laine  9   10 , Patrick Ecollan  11 , Josiane Boularan  12 , Vincent Bounes  7 , Benoit Vivien  13 , Papa-Ngalgou Gueye  14   15
Affiliations

Prehospital norepinephrine administration reduces 30-day mortality among septic shock patients

Romain Jouffroy et al. BMC Infect Dis. .

Abstract

Background: Despite differences in time of sepsis recognition, recent studies support that early initiation of norepinephrine in patients with septic shock (SS) improves outcome without an increase in adverse effects. This study aims to investigate the relationship between 30-day mortality in patients with SS and prehospital norepinephrine infusion in order to reach a mean blood pressure (MAP) > 65 mmHg at the end of the prehospital stage.

Methods: From April 06th, 2016 to December 31th, 2020, patients with SS requiring prehospital Mobile Intensive Care Unit intervention (MICU) were retrospectively analysed. To consider cofounders, the propensity score method was used to assess the relationship between prehospital norepinephrine administration in order to reach a MAP > 65 mmHg at the end of the prehospital stage and 30-day mortality.

Results: Four hundred and seventy-eight patients were retrospectively analysed, among which 309 patients (65%) were male. The mean age was 69 ± 15 years. Pulmonary, digestive, and urinary infections were suspected among 44%, 24% and 17% patients, respectively. One third of patients (n = 143) received prehospital norepinephrine administration with a median dose of 1.0 [0.5-2.0] mg h-1, among which 84 (69%) were alive and 38 (31%) were deceased on day 30 after hospital-admission. 30-day overall mortality was 30%. Cox regression analysis after the propensity score showed a significant association between prehospital norepinephrine administration and 30-day mortality, with an adjusted hazard ratio of 0.42 [0.25-0.70], p < 10-3. Multivariate logistic regression of IPTW retrieved a significant decrease of 30-day mortality among the prehospital norepinephrine group: ORa = 0.75 [0.70-0.79], p < 10-3.

Conclusion: In this study, we report that prehospital norepinephrine infusion in order to reach a MAP > 65 mmHg at the end of the prehospital stage is associated with a decrease in 30-day mortality in patients with SS cared for by a MICU in the prehospital setting. Further prospective studies are needed to confirm that very early norepinephrine infusion decreases septic shock mortality.

Keywords: Early; Mortality; Norepinephrine; Prehospital setting; Septic shock.

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Conflict of interest statement

None of the author.

Figures

Fig. 1
Fig. 1
Absolute mean differences between patients with prehospital norepinephrine optimisation and those without prehospital norepinephrine optimisation achievement after matching
Fig. 2
Fig. 2
Kaplan Meier curves for 30-days survival between patients with prehospital norepinephrine administration and those without prehospital norepinephrine administration
See this image and copyright information in PMC

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