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Intensive Care Med. 2018 Jun;44(6):847-856. doi: 10.1007/s00134-018-5222-9. Epub 2018 Jun 1.

Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients.

Author information

1
Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot and INSERM UMR-S 942, Paris, France.
2
Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, Paris, France.
3
Cardiology Department, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
4
Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
5
Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
6
Intensive Care Unit, University Hospital Félix Guyon, Saint Denis, France.
7
CIC-Plurithématique, INSERM, University Hospital of Nancy, Nancy, France.
8
Intensive Cardiac Care Unit, Florence University Hospital, Careggi, Florence, Italy.
9
Cardiovascular Department, Hôpital de la Tour, Meyrin-Geneva, Switzerland.
10
Department of Intensive Care, Austin Hospital, Melbourne, Australia.
11
Australian and New Zealand Intensive Care Research Centre (ANZIC RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
12
School of Medicine, The University of Melbourne, Melbourne, Australia.
13
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia.
14
Division of Nephrology, National University Health System, University Medicine Cluster, Singapore, Singapore.
15
Cardiology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
16
AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
17
Department of Medicine/Cardiology, Heart Center Dresden University of Technology, Dresden, Germany.
18
Praxisklinik Herz und Gefaesse, Dresden, Germany.
19
Intensive Care Unit, Faculty of Medicine, University Hospital of Nancy, France, and U1116, Vandoeuvre-lès-Nancy, France.
20
Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
21
Division of Cardiology, Henry Ford Hospital, 2799W. Grand Blvd - K14, Detroit, MI, 48202, USA.
22
Medical Intensive Care Unit, University Medical Centre Maribor, Ljubljanska, Maribor, Slovenia.
23
Department of Internal Medicine III, University of Cologne, Cologne, Germany.
24
Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot and INSERM UMR-S 942, Paris, France. alexandre.mebazaa@aphp.fr.
25
Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists, INI-CRCT, Nancy, France. alexandre.mebazaa@aphp.fr.
26
Emergency Department, University Hospital of Nancy, Nancy, France.
27
INSERM U1116, University of Lorraine, Nancy, France.

Abstract

OBJECTIVE:

Catecholamines have been the mainstay of pharmacological treatment of cardiogenic shock (CS). Recently, use of epinephrine has been associated with detrimental outcomes. In the present study we aimed to evaluate the association between epinephrine use and short-term mortality in all-cause CS patients.

DESIGN:

We performed a meta-analysis of individual data with prespecified inclusion criteria: (1) patients in non-surgical CS treated with inotropes and/or vasopressors and (2) at least 15% of patients treated with epinephrine administrated alone or in association with other inotropes/vasopressors. The primary outcome was short-term mortality.

MEASUREMENTS AND RESULTS:

Fourteen published cohorts and two unpublished data sets were included. We studied 2583 patients. Across all cohorts of patients, the incidence of epinephrine use was 37% (17-76%) and short-term mortality rate was 49% (21-69%). A positive correlation was found between percentages of epinephrine use and short-term mortality in the CS cohort. The risk of death was higher in epinephrine-treated CS patients (OR [CI] = 3.3 [2.8-3.9]) compared to patients treated with other drug regimens. Adjusted mortality risk remained striking in epinephrine-treated patients (n = 1227) (adjusted OR = 4.7 [3.4-6.4]). After propensity score matching, two sets of 338 matched patients were identified and epinephrine use remained associated with a strong detrimental impact on short-term mortality (OR = 4.2 [3.0-6.0]).

CONCLUSIONS:

In this very large cohort, epinephrine use for hemodynamic management of CS patients is associated with a threefold increase of risk of death.

KEYWORDS:

Cardiogenic shock; Epinephrine; Meta-analysis; Prognosis

PMID:
29858926
DOI:
10.1007/s00134-018-5222-9
[Indexed for MEDLINE]

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