Norepinephrine versus epinephrine for hemodynamic support in post-cardiac arrest shock: A systematic review
The preferred vasopressor in post-cardiac arrest shock has not been established with robust clinical outcomes data. Our goal was to perform a systematic review and meta-analysis comparing rates of in-hospital mortality, refractory shock, and hemodynamic parameters in post-cardiac arrest patients who...
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| Veröffentlicht in: | The American journal of emergency medicine 2024-03, Vol.77, p.158-163 |
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| creator | Lawson, Christine K. Faine, Brett A. Rech, Megan A. Childs, Christopher A. Brown, Caitlin S. Slocum, Giles W. Acquisto, Nicole M. Ray, Lance |
| description | The preferred vasopressor in post-cardiac arrest shock has not been established with robust clinical outcomes data. Our goal was to perform a systematic review and meta-analysis comparing rates of in-hospital mortality, refractory shock, and hemodynamic parameters in post-cardiac arrest patients who received either norepinephrine or epinephrine as primary vasopressor support.
We conducted a search of PubMed, Cochrane Library, and CINAHL from 2000 to 2022. Included studies were prospective, retrospective, or published abstracts comparing norepinephrine and epinephrine in adults with post-cardiac arrest shock or with cardiogenic shock and extractable post-cardiac arrest data. The primary outcome of interest was in-hospital mortality. Other outcomes included incidence of arrhythmias or refractory shock.
The database search returned 2646 studies. Two studies involving 853 participants were included in the systematic review. The proposed meta-analysis was deferred due to low yield. Crude incidence of in-hospital mortality was numerically higher in the epinephrine group compared with norepinephrine in both studies, but only statistically significant in one. Risk of bias was moderate to severe for in-hospital mortality. Additional outcomes were reported differently between studies, minimizing direct comparison.
The vasopressor with the best mortality and hemodynamic outcomes in post-cardiac arrest shock remains unclear. Randomized studies are crucial to remedy this. |
| doi_str_mv | 10.1016/j.ajem.2023.12.031 |
| format | Article |
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We conducted a search of PubMed, Cochrane Library, and CINAHL from 2000 to 2022. Included studies were prospective, retrospective, or published abstracts comparing norepinephrine and epinephrine in adults with post-cardiac arrest shock or with cardiogenic shock and extractable post-cardiac arrest data. The primary outcome of interest was in-hospital mortality. Other outcomes included incidence of arrhythmias or refractory shock.
The database search returned 2646 studies. Two studies involving 853 participants were included in the systematic review. The proposed meta-analysis was deferred due to low yield. Crude incidence of in-hospital mortality was numerically higher in the epinephrine group compared with norepinephrine in both studies, but only statistically significant in one. Risk of bias was moderate to severe for in-hospital mortality. Additional outcomes were reported differently between studies, minimizing direct comparison.
The vasopressor with the best mortality and hemodynamic outcomes in post-cardiac arrest shock remains unclear. Randomized studies are crucial to remedy this.</description><identifier>ISSN: 0735-6757</identifier><identifier>ISSN: 1532-8171</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2023.12.031</identifier><identifier>PMID: 38150986</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Bias ; Cardiac arrest ; Cardiac arrhythmia ; Catecholamines ; Clinical outcomes ; Creatinine ; Emergency medical care ; Epinephrine ; Epinephrine - therapeutic use ; Heart ; Heart Arrest - drug therapy ; Heart Arrest - mortality ; Heart Arrest - therapy ; Heart rate ; Hemodynamics ; Hemodynamics - drug effects ; Hospital Mortality ; Humans ; Meta-analysis ; Mortality ; Norepinephrine ; Norepinephrine - therapeutic use ; Population ; Post-resuscitation shock ; Return of spontaneous circulation ; Shock ; Shock - drug therapy ; Shock - etiology ; Shock, Cardiogenic - drug therapy ; Shock, Cardiogenic - etiology ; Shock, Cardiogenic - mortality ; Statistical analysis ; Systematic review ; Vasoconstrictor Agents - therapeutic use ; Vasopressors</subject><ispartof>The American journal of emergency medicine, 2024-03, Vol.77, p.158-163</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c335t-907fc18c453480a56fbaf5b45d9d463bb4493681adcda055663d6ded73b08f113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735675723007106$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38150986$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lawson, Christine K.</creatorcontrib><creatorcontrib>Faine, Brett A.</creatorcontrib><creatorcontrib>Rech, Megan A.</creatorcontrib><creatorcontrib>Childs, Christopher A.</creatorcontrib><creatorcontrib>Brown, Caitlin S.</creatorcontrib><creatorcontrib>Slocum, Giles W.</creatorcontrib><creatorcontrib>Acquisto, Nicole M.</creatorcontrib><creatorcontrib>Ray, Lance</creatorcontrib><creatorcontrib>On behalf of the EMPHARM-NET Study Group</creatorcontrib><creatorcontrib>EMPHARM-NET Study Group</creatorcontrib><title>Norepinephrine versus epinephrine for hemodynamic support in post-cardiac arrest shock: A systematic review</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>The preferred vasopressor in post-cardiac arrest shock has not been established with robust clinical outcomes data. Our goal was to perform a systematic review and meta-analysis comparing rates of in-hospital mortality, refractory shock, and hemodynamic parameters in post-cardiac arrest patients who received either norepinephrine or epinephrine as primary vasopressor support.
We conducted a search of PubMed, Cochrane Library, and CINAHL from 2000 to 2022. Included studies were prospective, retrospective, or published abstracts comparing norepinephrine and epinephrine in adults with post-cardiac arrest shock or with cardiogenic shock and extractable post-cardiac arrest data. The primary outcome of interest was in-hospital mortality. Other outcomes included incidence of arrhythmias or refractory shock.
The database search returned 2646 studies. Two studies involving 853 participants were included in the systematic review. The proposed meta-analysis was deferred due to low yield. Crude incidence of in-hospital mortality was numerically higher in the epinephrine group compared with norepinephrine in both studies, but only statistically significant in one. Risk of bias was moderate to severe for in-hospital mortality. Additional outcomes were reported differently between studies, minimizing direct comparison.
The vasopressor with the best mortality and hemodynamic outcomes in post-cardiac arrest shock remains unclear. Randomized studies are crucial to remedy this.</description><subject>Bias</subject><subject>Cardiac arrest</subject><subject>Cardiac arrhythmia</subject><subject>Catecholamines</subject><subject>Clinical outcomes</subject><subject>Creatinine</subject><subject>Emergency medical care</subject><subject>Epinephrine</subject><subject>Epinephrine - therapeutic use</subject><subject>Heart</subject><subject>Heart Arrest - drug therapy</subject><subject>Heart Arrest - mortality</subject><subject>Heart Arrest - therapy</subject><subject>Heart rate</subject><subject>Hemodynamics</subject><subject>Hemodynamics - drug effects</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Norepinephrine</subject><subject>Norepinephrine - therapeutic use</subject><subject>Population</subject><subject>Post-resuscitation shock</subject><subject>Return of spontaneous circulation</subject><subject>Shock</subject><subject>Shock - drug therapy</subject><subject>Shock - etiology</subject><subject>Shock, Cardiogenic - drug therapy</subject><subject>Shock, Cardiogenic - etiology</subject><subject>Shock, Cardiogenic - mortality</subject><subject>Statistical analysis</subject><subject>Systematic review</subject><subject>Vasoconstrictor Agents - therapeutic use</subject><subject>Vasopressors</subject><issn>0735-6757</issn><issn>1532-8171</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kc2L1TAUxYMoznP0H3AhATduWnObj6biZhj8gkE3ug5pcstL57WpSTvD--_N440iLtzkQvidcy_nEPISWA0M1NuxtiNOdcMaXkNTMw6PyA4kbyoNLTwmO9ZyWalWthfkWc4jYwBCiqfkgmuQrNNqR26_xoRLmHHZp_LSO0x5y_TvryEmuscp-uNsp-Bo3pYlppWGmS4xr5WzyQfrqE0J80rzPrrbd_SK5mNecbJrkSS8C3j_nDwZ7CHji4d5SX58_PD9-nN18-3Tl-urm8pxLteqY-3gQDshudDMSjX0dpC9kL7zQvG-F6LjSoP1zlsmpVLcK4--5T3TAwC_JG_OvkuKP7dyk5lCdng42Bnjlk1TNkCntOQFff0POsYtzeW6QjWi01ozUajmTLkUc044mCWFyaajAWZOVZjRnKowpyoMNKZUUUSvHqy3fkL_R_I7-wK8PwNYsij5JJNdwNmhDwndanwM__P_BReEm20</recordid><startdate>202403</startdate><enddate>202403</enddate><creator>Lawson, Christine K.</creator><creator>Faine, Brett A.</creator><creator>Rech, Megan A.</creator><creator>Childs, Christopher A.</creator><creator>Brown, Caitlin S.</creator><creator>Slocum, Giles W.</creator><creator>Acquisto, Nicole M.</creator><creator>Ray, Lance</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202403</creationdate><title>Norepinephrine versus epinephrine for hemodynamic support in post-cardiac arrest shock: A systematic review</title><author>Lawson, Christine K. ; Faine, Brett A. ; Rech, Megan A. ; Childs, Christopher A. ; Brown, Caitlin S. ; Slocum, Giles W. ; Acquisto, Nicole M. ; Ray, Lance</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c335t-907fc18c453480a56fbaf5b45d9d463bb4493681adcda055663d6ded73b08f113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Bias</topic><topic>Cardiac arrest</topic><topic>Cardiac arrhythmia</topic><topic>Catecholamines</topic><topic>Clinical outcomes</topic><topic>Creatinine</topic><topic>Emergency medical care</topic><topic>Epinephrine</topic><topic>Epinephrine - therapeutic use</topic><topic>Heart</topic><topic>Heart Arrest - drug therapy</topic><topic>Heart Arrest - mortality</topic><topic>Heart Arrest - therapy</topic><topic>Heart rate</topic><topic>Hemodynamics</topic><topic>Hemodynamics - drug effects</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Norepinephrine</topic><topic>Norepinephrine - therapeutic use</topic><topic>Population</topic><topic>Post-resuscitation shock</topic><topic>Return of spontaneous circulation</topic><topic>Shock</topic><topic>Shock - drug therapy</topic><topic>Shock - etiology</topic><topic>Shock, Cardiogenic - drug therapy</topic><topic>Shock, Cardiogenic - etiology</topic><topic>Shock, Cardiogenic - mortality</topic><topic>Statistical analysis</topic><topic>Systematic review</topic><topic>Vasoconstrictor Agents - therapeutic use</topic><topic>Vasopressors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lawson, Christine K.</creatorcontrib><creatorcontrib>Faine, Brett A.</creatorcontrib><creatorcontrib>Rech, Megan A.</creatorcontrib><creatorcontrib>Childs, Christopher A.</creatorcontrib><creatorcontrib>Brown, Caitlin S.</creatorcontrib><creatorcontrib>Slocum, Giles W.</creatorcontrib><creatorcontrib>Acquisto, Nicole M.</creatorcontrib><creatorcontrib>Ray, Lance</creatorcontrib><creatorcontrib>On behalf of the EMPHARM-NET Study Group</creatorcontrib><creatorcontrib>EMPHARM-NET Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lawson, Christine K.</au><au>Faine, Brett A.</au><au>Rech, Megan A.</au><au>Childs, Christopher A.</au><au>Brown, Caitlin S.</au><au>Slocum, Giles W.</au><au>Acquisto, Nicole M.</au><au>Ray, Lance</au><aucorp>On behalf of the EMPHARM-NET Study Group</aucorp><aucorp>EMPHARM-NET Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Norepinephrine versus epinephrine for hemodynamic support in post-cardiac arrest shock: A systematic review</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2024-03</date><risdate>2024</risdate><volume>77</volume><spage>158</spage><epage>163</epage><pages>158-163</pages><issn>0735-6757</issn><issn>1532-8171</issn><eissn>1532-8171</eissn><abstract>The preferred vasopressor in post-cardiac arrest shock has not been established with robust clinical outcomes data. Our goal was to perform a systematic review and meta-analysis comparing rates of in-hospital mortality, refractory shock, and hemodynamic parameters in post-cardiac arrest patients who received either norepinephrine or epinephrine as primary vasopressor support.
We conducted a search of PubMed, Cochrane Library, and CINAHL from 2000 to 2022. Included studies were prospective, retrospective, or published abstracts comparing norepinephrine and epinephrine in adults with post-cardiac arrest shock or with cardiogenic shock and extractable post-cardiac arrest data. The primary outcome of interest was in-hospital mortality. Other outcomes included incidence of arrhythmias or refractory shock.
The database search returned 2646 studies. Two studies involving 853 participants were included in the systematic review. The proposed meta-analysis was deferred due to low yield. Crude incidence of in-hospital mortality was numerically higher in the epinephrine group compared with norepinephrine in both studies, but only statistically significant in one. Risk of bias was moderate to severe for in-hospital mortality. Additional outcomes were reported differently between studies, minimizing direct comparison.
The vasopressor with the best mortality and hemodynamic outcomes in post-cardiac arrest shock remains unclear. Randomized studies are crucial to remedy this.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38150986</pmid><doi>10.1016/j.ajem.2023.12.031</doi><tpages>6</tpages></addata></record> |
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| subjects | Bias Cardiac arrest Cardiac arrhythmia Catecholamines Clinical outcomes Creatinine Emergency medical care Epinephrine Epinephrine - therapeutic use Heart Heart Arrest - drug therapy Heart Arrest - mortality Heart Arrest - therapy Heart rate Hemodynamics Hemodynamics - drug effects Hospital Mortality Humans Meta-analysis Mortality Norepinephrine Norepinephrine - therapeutic use Population Post-resuscitation shock Return of spontaneous circulation Shock Shock - drug therapy Shock - etiology Shock, Cardiogenic - drug therapy Shock, Cardiogenic - etiology Shock, Cardiogenic - mortality Statistical analysis Systematic review Vasoconstrictor Agents - therapeutic use Vasopressors |
| title | Norepinephrine versus epinephrine for hemodynamic support in post-cardiac arrest shock: A systematic review |
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