In this episode, I’ll discuss what vasopressor to use in post-resuscitation shock.
The ideal choice of vasopressor for post resuscitative shock is unknown, and researchers from the Paris Cardiovascular Research Center conducted an observational multicenter study to determine whether epinephrine or norepinephrine was the superior vasopressor to use in this situation.
Nearly 800 patients at 5 hospitals were included in the analysis. The primary outcome was all-cause in-hospital mortality, and secondary outcomes were cardiovascular in-hospital mortality and unfavorable neurological outcome.
Norepinephrine was the more common vasopressor used by about a 2:1 ratio.
The authors found all-cause in-hospital mortality was significantly higher in the epinephrine group with an odds ratio of 2.6. Furthermore, the odds ratio for cardiovascular in-hospital mortality was 5.5 for epinephrine.
The measure of poor neurological outcome was a Cerebral Performance Category of 3, 4, or 5. The Cerebral Performance Category score roughly corresponds to quality of life and functional status with a score of 3 meaning disability is severe enough for the patient to be dependent on others for care, a score of 4 meaning coma, and a score of 5 meaning brain death.
The proportion of patients with Cerebral Performance Category score of 3–5 at hospital discharge was significantly higher in the epinephrine group.
While the study design is not the highest possible type of evidence, it would seem reasonable to prefer norepinephrine to treat post-resuscitative shock until a randomized prospective trial can provide more information on the ideal pressor to use.
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