• Wulfran Bougouin, Kaci Slimani, Marie Renaudier, Yannick Binois, Marine Paul, Florence Dumas, Lionel Lamhaut, Thomas Loeb, Sofia Ortuno, Nicolas Deye, Sebastian Voicu, Frankie Beganton, Daniel Jost, Armand Mekontso-Dessap, Eloi Marijon, Xavier Jouven, Nadia Aissaoui, Alain Cariou, and Sudden Death Expertise Center Investigators.
• Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.
• Intensive Care Med. 2022 Mar 1; 48 (3): 300-310.

PurposeWhether 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.MethodsWe 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.ResultsOf 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).ConclusionAmong 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.© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.

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