清晨好,您是今天最早来到科研通的研友!由于当前在线用户较少,发布求助请尽量完整的填写文献信息,科研通机器人24小时在线,伴您科研之路漫漫前行!

Comparison of Clinical Outcomes with Initial Norepinephrine or Epinephrine for Hemodynamic Support After Return of Spontaneous Circulation

自然循环恢复 医学 急诊科 肾上腺素 高级心脏生命支持 复苏 心肺复苏术 麻醉 急诊医学 去甲肾上腺素 入射(几何) 目标温度管理 血流动力学 回顾性队列研究 内科学 多巴胺 物理 精神科 光学
作者
Ashley Weiss,Cathyyen Dang,Danielle Mabrey,Matthew Stanton,Jessica Feih,Lisa Rein,Ryan Feldman
出处
期刊:Shock [Ovid Technologies (Wolters Kluwer)]
卷期号:56 (6): 988-993 被引量:7
标识
DOI:10.1097/shk.0000000000001830
摘要

The optimal vasoactive agent for management of patients with return of spontaneous circulation (ROSC) after cardiac arrest has not yet been identified. The Advanced Cardiac Life Support guidelines recommend initiation of either norepinephrine (NE), epinephrine (EPI), or dopamine (DA) to maintain adequate hemodynamics after ROSC is achieved. The goal of this study is to retrospectively assess the impact of initial vasopressor agent on incidence rate of rearrest, death, or need for additional vasopressor in post-cardiac arrest emergency department (ED) patients.A retrospective review of electronic medical records was conducted at a tertiary care, academic medical center over a 32-month period. Inclusion criteria were any patient who received vasopressors in the ED after achieving ROSC from out-of-hospital cardiac arrest, or in ED cardiac arrest. The incidence of the primary outcome was assessed during care within the ED, at 6 h regardless of location (early resuscitation period), and throughout the entire hospitalization. Secondary outcomes included incidence of tachyarrhythmia while on vasopressor, type of additional therapy needed for refractory shock, and functional status at discharge as determined by discharge location (discharged home without assistance, or discharged to long-term care facility, subacute rehabilitation, or assisted living).A total of 93 patients were included for analysis; 45 received NE, 42 EPI, and six DA. Due to small sample size, DA was excluded from reporting post hoc. Significantly more EPI patients met the primary outcome of refractory hypotension, rearrest, or death in the emergency department (EPI 21/42, 50% vs. NE 10/45, 22.2%; P = 0.008). The incidence was no longer significantly different during the early resuscitation period of 6 h (EPI 30/42, 71.4% vs. NE 25/45, 55.6%; P = 0.182), or during the entire hospitalization (EPI 40/42, 95.2% vs. NE 36/45, 80.0%; P = 0.051). Notably, the EPI group had higher rates of rearrest prior to vasopressor initiation, potentially signaling more severe illness despite other prognostic variables being similarly distributed. In an adjusted regression model, which included adjustment for rearrest prior to vasopressor initiation, the odds of reaching the primary outcome in the ED were 3.94 [95%CI 1.38-12.2] (P = 0.013) times higher in the EPI group compared to NE treated patients. No difference in tachyarrhythmia or functional status at discharge was detected between groups.These data suggest prospective study of initial vasopressors used for hemodynamic support after ROSC may be warranted. Rates of intra-emergency department refractory shock, rearrest, or death were higher among epinephrine treated patients compared to norepinephrine treated patients in this population. However, inability to control for potential confounding variables in retrospective studies limits the findings. These results are hypothesis generating and further study is warranted.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
拓跋雨梅完成签到 ,获得积分0
20秒前
郭星星完成签到,获得积分10
23秒前
个性仙人掌完成签到 ,获得积分10
26秒前
Echoheart完成签到,获得积分10
46秒前
咯咯咯完成签到 ,获得积分10
55秒前
淡淡醉波wuliao完成签到 ,获得积分10
1分钟前
even完成签到 ,获得积分10
1分钟前
研友_Z119gZ完成签到 ,获得积分10
1分钟前
沙海沉戈完成签到,获得积分0
1分钟前
Shandongdaxiu完成签到 ,获得积分10
2分钟前
如意的馒头完成签到 ,获得积分10
2分钟前
kenchilie完成签到 ,获得积分10
2分钟前
Summer_Xia完成签到 ,获得积分10
5分钟前
6分钟前
小郭发布了新的文献求助20
6分钟前
不安青牛应助偷西瓜的猹采纳,获得10
6分钟前
6分钟前
小郭发布了新的文献求助10
6分钟前
吉吉完成签到 ,获得积分10
7分钟前
7分钟前
小马甲应助小郭采纳,获得10
7分钟前
apathetic完成签到,获得积分10
7分钟前
7分钟前
妮子拉完成签到,获得积分10
7分钟前
遥感小虫发布了新的文献求助10
7分钟前
8分钟前
紫熊完成签到,获得积分10
8分钟前
8分钟前
LIVE完成签到,获得积分10
8分钟前
8分钟前
Jenny完成签到,获得积分10
9分钟前
刘刘完成签到 ,获得积分10
9分钟前
结实的忆枫完成签到,获得积分10
9分钟前
寻道图强应助结实的忆枫采纳,获得30
10分钟前
amar完成签到 ,获得积分0
10分钟前
10分钟前
11分钟前
11分钟前
12分钟前
月军完成签到,获得积分10
12分钟前
高分求助中
Evolution 10000
ISSN 2159-8274 EISSN 2159-8290 1000
Becoming: An Introduction to Jung's Concept of Individuation 600
Ore genesis in the Zambian Copperbelt with particular reference to the northern sector of the Chambishi basin 500
A new species of Coccus (Homoptera: Coccoidea) from Malawi 500
A new species of Velataspis (Hemiptera Coccoidea Diaspididae) from tea in Assam 500
PraxisRatgeber: Mantiden: Faszinierende Lauerjäger 500
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 基因 遗传学 催化作用 物理化学 免疫学 量子力学 细胞生物学
热门帖子
关注 科研通微信公众号,转发送积分 3162343
求助须知:如何正确求助?哪些是违规求助? 2813330
关于积分的说明 7899736
捐赠科研通 2472848
什么是DOI,文献DOI怎么找? 1316533
科研通“疑难数据库(出版商)”最低求助积分说明 631375
版权声明 602142