Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients

Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of... 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 Measurements and results: Fourteen published cohorts and two unpublished data sets were included.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 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Intensive Care Medicine Springer Journals
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Publisher
Springer Berlin Heidelberg
Copyright
Copyright © 2018 by Springer-Verlag GmbH Germany, part of Springer Nature and ESICM
Subject
Medicine & Public Health; Intensive / Critical Care Medicine; Anesthesiology; Emergency Medicine; Pneumology/Respiratory System; Pain Medicine; Pediatrics
ISSN
0342-4642
eISSN
1432-1238
D.O.I.
10.1007/s00134-018-5222-9
Publisher site
See Article on Publisher Site

Abstract

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

Journal

Intensive Care MedicineSpringer Journals

Published: Jun 1, 2018

References

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