Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest: Prognostic implications

TY - JOUR

T1 - Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest

T2 - Prognostic implications

AU - Bro-Jeppesen, John

AU - Kjaergaard, Jesper

AU - Søholm, Helle

AU - Wanscher, Michael

AU - Lippert, Freddy K

AU - Møller, Jacob E

AU - Køber, Lars

AU - Hassager, Christian

N1 - Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

PY - 2014/5

Y1 - 2014/5

N2 - Aim: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopressor support and mortality. Methods: In a 6-year period, 310 comatose OHCA patients treated with TH were included. Temperature, hemodynamic parameters and level of vasopressors were registered from admission to 24. h after rewarming. Level of vasopressor support was assessed by the cardiovascular sub-score of Sequential Organ Failure Assessment (SOFA). The population was stratified by use of dopamine as first line intervention (D-group) or use of dopamine. +. norepinephrine/epinephrine (DA-group). Primary endpoint was 30-day mortality and secondary endpoint was in-hospital cause of death. Results: Patients in the DA-group carried a 49% all-cause 30-day mortality rate compared to 23% in the D-group, plog-rank<0.0001, corresponding to an adjusted hazard ratio (HR) of 2.0 (95% CI: 1.3-3.0), p=0.001). The DA-group had an increased 30-day mortality due to neurological injury (HR=1.7 (95% CI: 1.1-2.7), p=0.02). Cause of death was anoxic brain injury in 78%, cardiovascular failure in 18% and multi-organ failure in 4%. The hemodynamic changes of TH reversed at normothermia, although the requirement for vasopressor support (cardiovascular SOFA≥3) persisted in 80% of patients. Conclusions: In survivors after OHCA treated with TH the induced hemodynamic changes reversed after normothermia, while the need for vasopressor support persisted. Patients requiring addition of norepinephrine/epinephrine on top of dopamine had an increased 30-day all-cause mortality, as well as death from neurological injury.

AB - Aim: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopressor support and mortality. Methods: In a 6-year period, 310 comatose OHCA patients treated with TH were included. Temperature, hemodynamic parameters and level of vasopressors were registered from admission to 24. h after rewarming. Level of vasopressor support was assessed by the cardiovascular sub-score of Sequential Organ Failure Assessment (SOFA). The population was stratified by use of dopamine as first line intervention (D-group) or use of dopamine. +. norepinephrine/epinephrine (DA-group). Primary endpoint was 30-day mortality and secondary endpoint was in-hospital cause of death. Results: Patients in the DA-group carried a 49% all-cause 30-day mortality rate compared to 23% in the D-group, plog-rank<0.0001, corresponding to an adjusted hazard ratio (HR) of 2.0 (95% CI: 1.3-3.0), p=0.001). The DA-group had an increased 30-day mortality due to neurological injury (HR=1.7 (95% CI: 1.1-2.7), p=0.02). Cause of death was anoxic brain injury in 78%, cardiovascular failure in 18% and multi-organ failure in 4%. The hemodynamic changes of TH reversed at normothermia, although the requirement for vasopressor support (cardiovascular SOFA≥3) persisted in 80% of patients. Conclusions: In survivors after OHCA treated with TH the induced hemodynamic changes reversed after normothermia, while the need for vasopressor support persisted. Patients requiring addition of norepinephrine/epinephrine on top of dopamine had an increased 30-day all-cause mortality, as well as death from neurological injury.

KW - Cause of Death

KW - Coma

KW - Comorbidity

KW - Dopamine

KW - Epinephrine

KW - Female

KW - Hemodynamics

KW - Hospital Mortality

KW - Humans

KW - Hypothermia, Induced

KW - Male

KW - Middle Aged

KW - Norepinephrine

KW - Out-of-Hospital Cardiac Arrest

KW - Prognosis

KW - Survival Rate

KW - Sympathomimetics

KW - Treatment Outcome

U2 - 10.1016/j.resuscitation.2013.12.031

DO - 10.1016/j.resuscitation.2013.12.031

M3 - Journal article

C2 - 24412644

SN - 0300-9572

VL - 85

SP - 664

EP - 670

JO - Resuscitation

JF - Resuscitation

IS - 5

ER -