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Title: Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients.
Austin Authors: Léopold, Valentine;Gayat, Etienne;Pirracchio, Romain;Spinar, Jindrich;Parenica, Jiri;Tarvasmäki, Tuukka;Lassus, Johan;Harjola, Veli-Pekka;Champion, Sébastien;Zannad, Faiez;Valente, Serafina;Urban, Philip;Chua, Horng-Ruey;Bellomo, Rinaldo ;Popovic, Batric;Ouweneel, Dagmar M;Henriques, José P S;Simonis, Gregor;Lévy, Bruno;Kimmoun, Antoine;Gaudard, Philippe;Basir, Mir Babar;Markota, Andrej;Adler, Christoph;Reuter, Hannes;Mebazaa, Alexandre;Chouihed, Tahar
Affiliation: Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists, INI-CRCT, Nancy, France
Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot and INSERM UMR-S 942, Paris, France
Department of Internal Medicine III, University of Cologne, Cologne, Germany
Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, Paris, France
Cardiology Department, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
Intensive Care Unit, University Hospital Félix Guyon, Saint Denis, France
CIC-Plurithématique, INSERM, University Hospital of Nancy, Nancy, France
Intensive Cardiac Care Unit, Florence University Hospital, Careggi, Florence, Italy
Cardiovascular Department, Hôpital de la Tour, Meyrin-Geneva, Switzerland
Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
Australian and New Zealand Intensive Care Research Centre (ANZIC RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
School of Medicine, The University of Melbourne, Melbourne, Australia
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
Division of Nephrology, National University Health System, University Medicine Cluster, Singapore, Singapore
Cardiology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Department of Medicine/Cardiology, Heart Center Dresden University of Technology, Dresden, Germany
Praxisklinik Herz und Gefaesse, Dresden, Germany
Intensive Care Unit, Faculty of Medicine, University Hospital of Nancy, France, and U1116, Vandoeuvre-lès-Nancy, France
Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
Division of Cardiology, Henry Ford Hospital, 2799W. Grand Blvd - K14, Detroit, MI, 48202, USA
Medical Intensive Care Unit, University Medical Centre Maribor, Ljubljanska, Maribor, Slovenia
Emergency Department, University Hospital of Nancy, Nancy, France
INSERM U1116, University of Lorraine, Nancy, France
Issue Date: 2018
Date: 2018-06-01
Publication information: Intensive Care Medicine 2018; 44(6): 847-856
Abstract: 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. 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. 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]). In this very large cohort, epinephrine use for hemodynamic management of CS patients is associated with a threefold increase of risk of death.
DOI: 10.1007/s00134-018-5222-9
ORCID: 0000-0003-1379-0585
Journal: Intensive Care Medicine
PubMed URL: 29858926
Type: Journal Article
Subjects: Cardiogenic shock
Appears in Collections:Journal articles

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