Intensive Care Med (2018) 44:847–856
Epinephrine and short-term survival
in cardiogenic shock: an individual data
meta-analysis of 2583 patients
, Etienne Gayat
, Romain Pirracchio
, Jindrich Spinar
, Jiri Parenica
, Tuukka Tarvasmäki
, Veli‑Pekka Harjola
, Sébastien Champion
, Faiez Zannad
, Seraﬁna Valente
, Philip Urban
, Rinaldo Bellomo
, Batric Popovic
, Dagmar M. Ouweneel
José P. S. Henriques
, Gregor Simonis
, Bruno Lévy
, Antoine Kimmoun
, Philippe Gaudard
Mir Babar Basir
, Andrej Markota
, Christoph Adler
, Hannes Reuter
, Alexandre Mebazaa
and Tahar Chouihed
© 2018 Springer‑Verlag GmbH Germany, part of Springer Nature and ESICM
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 evalu‑
ate 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‑sur‑
gical CS treated with inotropes and/or vasopressors and (2) at least 15% of patients treated with epinephrine adminis‑
trated 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Measurements and results: Fourteen published cohorts and two unpublished data sets were included.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 stud‑
ied 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: Meta‑analysis, Cardiogenic shock, Epinephrine, Prognosis
Cardiogenic shock (CS) is a state characterized by acute
cardiac failure leading to low cardiac output, hypoten
sion, and end-organ hypoperfusion . CS is mostly
related to acute coronary syndrome (ACS) and its mor
tality remains high despite improvements in ACS revas-
cularization therapies . e pharmacologic treatment
Department of Anesthesiology and Critical Care, APHP ‑ Saint Louis
Lariboisière University Hospitals, University Paris Diderot and INSERM
UMR‑S 942, Paris, France
Full author information is available at the end of the article
Valentine Léopold and Etienne Gayat are co‑ﬁrst authors.
Alexandre Mebazaa and Tahar Chouihed are co‑last authors.