• Abigail R Sharpe, Kelly Richardson, Matthew Stanton, Cathyyen Dang, Jessica Feih, Ruta Brazauskas, Bi Qing Teng, and Ryan Feldman.
• Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin.
• J Emerg Med. 2023 Sep 1; 65 (3): e209e220e209-e220.

BackgroundCardiac arrest occurs in approximately 350,000 patients outside the hospital and approximately 30,000 patients in the emergency department (ED) annually in the United States. When return of spontaneous circulation (ROSC) is achieved, hypotension is a common complication. However, optimal dosing of vasopressors is not clear.ObjectiveThe objective of this study was to determine if initial vasopressor dosing was associated with cardiac re-arrest in patients after ROSC.MethodsThis was a retrospective, single-center analysis of adult patients experiencing cardiac arrest prior to arrival or within the ED. Patients were assigned to one of four groups based on starting dose of vasopressor: low dose (LD; < 0.25 µg/kg/min), medium dose (MD; 0.25-0.49 µg/kg/min), high dose (HD; 0.5-0.99 µg/kg/min), and very high dose (VHD; ≥ 1 µg/kg/min). Data collection was performed primarily via manual chart review of medical records. The primary outcome was incidence of cardiac re-arrest within 1 h of vasopressor initiation. Multivariate logistic regression analysis was conducted to identify any covariates strongly associated with the primary outcome.ResultsNo difference in cardiac re-arrest incidence was noted between groups. The VHD group was significantly more likely to require a second vasopressor (p = 0.003). The HD group had lower survival rates to hospital discharge compared with the LD and MD groups (p = 0.0033 and p = 0.0147). In the multivariate regression, longer duration of pre-vasopressor re-arrests and hyperkalemic cardiac arrest etiology were significant predictors of cardiac re-arrest after vasopressor initiation.ConclusionsInitial vasopressor dosing was not found to be associated with risk of cardiac re-arrest or, conversely, risk of adverse events.Copyright © 2023 Elsevier Inc. All rights reserved.

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