Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock

Slimani, Kaci; Renaudier, Marie; Binois, Yannick; Paul, Marine; Ortuno, Sofia; Jost, Daniel; Aïssaoui, Nadia; Adnet, Frédéric; Agostinucci, Jean-Marc; Aissaoui-Balanant, N.; Algalarrondo, Vincent; Alla, François; Alonso, Christine; Amara, W.; Annane, Djillali; Antoine, Corinne; Aubry, P; Azoulay, Élie; Beganton, Frankie; Billon, C.; Bougouin, Wulfran; Boutet, J; Bruel, Cédric; Bruneval, Patrick; Cariou, Alain; Carli, Pierre; Casalino, Enrique; Cerf, Charles; Chaïb, Aurès; Cholley, Bernard; Cohen, Yves; Combes, Alain; Coulaud, J. M.; Crahès, Marie; Silva, D. Da; Das, Vijay Kumar; Demoule, Alexandre; Denjoy, Isabelle; Deye, Nicolas; Diehl, Jean Luc; Dinanian, S.; Domanski, Luke; Dreyfuss, Didier; Duboc, D; Dubois-Randé, J.-L.; Dumas, Florence; Duranteau, Jacques; Empana, Jean‐Philippe; Extramiana, Fabrice; Fagon, Jean-Yves; Fartoukh, Muriel; Fieux, Fabienne; Gabbas, Marco; Gandjbakhch, Estelle; Géri, Guillaume; Guidet, Bertrand; Halimi, Franck; Henry, Patrick; Lucet, F Hidden; Jabre, P.; Joseph, Lee; Jost, Daniel; Jouven, Xavier; Karam, Nicole; Kassim, H.; Lacotte, Jérôme; Lahlou‐Laforêt, Khadija; Lamhaut, Lionel; Lanceleur, A.; Langeron, Olivier; Lavergne, Thomas; Lecarpentier, Éric; Leenhardt, A.; Lellouche, Nicolas; Lemiale, Virginie; Lemoine, Frédéric; Linval, F.; Loeb, Thomas; Ludes, Bertrand; Luyt, Charles‐Édouard; Maltret, Alice; Mansencal, Nicolas; Mansouri, Nadia; Marijon, Éloi; Marty, J.; Maury, Éric; Maxime, Virginie; Mégarbane, Bruno; Mekontso-Dessap, Armand; Mentec, Hervé; Mira, Jean‐Paul; Monnet, Xavier; Narayanan, Kumar; Ngoyi, N; Perier, Marie Cécile; Piot, Olivier; Pirracchio, Romain; Plaisance, Patrick; Plaud, Benoît; Plu, Isabelle; Raphalen, Jean Herlé; Raux, Mathieu; Revaux, François; Ricard, J. D.; Richard, Corinne Miceli; Riou, Bruno; Roussin, France; Santoli, François; Schortgen, Frédérique; Sharifzadehgan, Ardalan; Sharshar, Tarek; Sidéris, Georgios; Similowski, Thomas; Spaulding, Christian; Teboul, Jean Louis; Timsit, JF; Tourtier, Jean Pierre; Tuppin, Philippe; Ursat, Cécile; Varenne, Olivier; Vieillard‐Baron, Antoine; Voicu, Sébastian; Wahbi, Karim; Waldman, V.

doi:10.1007/s00134-021-06608-7

Cited by 28 publications

(14 citation statements)

References 49 publications

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“…Although the benefits and risks of adrenaline during cardiac arrests have been explored in large studies (2), post-ROSC adrenaline is an area of limited research. The optimal drug for post-resuscitation shock lacks high quality evidence (10). Variance in doses needs to be explored to ensure therapeutic doses are given and do not cause harm to patients.…”

Section: Discussionmentioning

confidence: 99%

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Paramedic Practice in England with Adrenaline Following Return Of Spontaneous Circulation (ROSC)

Webb¹

2022

Preprint

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Background Post-resuscitation shock is a condition witnessed by paramedics following out of hospital cardiac arrest. Paramedic practice within England is largely influenced by clinical guidelines from the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). Currently JRCALC recommend local Ambulance Services to produce guidance for administration of adrenaline following return of spontaneous circulation (ROSC) in out of hospital card arrest. Aims To understand what current practice is undertaken for adrenaline administration by non-specialist paramedics within England following ROSC. Methods An electronic anonymous survey shared on social media that is open to non-specialist paramedics in England. The survey involved frequency distribution questions, Likert ratings and a clinical scenario. Results The survey was fully completed by 98 non-specialist paramedics. The majority (75% n = 74) reported that they had a clinical guideline to follow from their employer. Paramedics experience of patients achieving ROSC varied. The survey found 83.67% ( n = 82) reported ROSC one or more times in the last 12 months. Over half of the respondents have given adrenaline following ROSC (57.14%, n = 56 ). A proportion of paramedics ( n = 8) have given adrenaline following ROSC without any local guideline available. Paramedics reported high levels of confidence in their ability to administer adrenaline in ROSC. However, the absence of a clinical guideline is the primary reason paramedics do not administer adrenaline. Following this respondents primarily chose to transport the patient to hospital. The majority of patients chose to administer 250ml sodium chloride within the first 5 minutes. The dose of adrenaline varies across paramedic practice. The main doses were 10mcg and 100mcg selected to be administered. Conclusion Non-specialist paramedic practice for post ROSC adrenaline administration is undertaken by paramedics within England. However, the availability of a local clinical guideline varies and reduces paramedics ability to administer this as a treatment option. Dosing of adrenaline in paramedic practice has a large variance from 10mcg to 100mcg. The standardisation of paramedic practice in a national clinical guideline should be explored further to ensure safe and equal availability of care to for patients across England.

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Section: Discussionmentioning

confidence: 99%

“…The majority of research is undertaken in intensive care units or emergency departments (7,8,9,10). However, many patients where ROSC is achieved on-scene, re-arrest and die before entering trials for this literature.…”

Section: Introductionmentioning

confidence: 99%

Paramedic Practice in England with Adrenaline Following Return Of Spontaneous Circulation (ROSC)

Webb¹

2022

Preprint

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“…Bougouin et al 3 conducted an observational cohort study comparing all-cause hospital mortality between patients treated with norepinephrine and epinephrine. The study used registry data comprising all out-of-hospital cardiac arrests presenting to five university hospitals in Paris with post-resuscitation shock, defined as a need for vasopressors for more than 6 hours post-ROSC despite adequate fluid loading.…”

Section: Epinephrine Vs Norepinephrine In Cardiac Arrest Patients Wit...mentioning

confidence: 99%

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et al. 2022

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“…[4][5][6] Increasing MAP by administering low doses of vasopressors is possible after CA; noradrenaline is the usual first-line vasopressor. [7][8]9 Vasopressors may have adverse effects, including cardiac arrhythmias and increased myocardial oxygen consumption that can result in ischaemia and afterload elevation. 10 Severe side effects include re-arrest and/or the use of mechanical circulatory support.…”

Section: Introductionmentioning

confidence: 99%

“…Pilot studies have suggested alleviation of brain injury by targeting a higher mean arterial pressure after CA 4–6 . Increasing MAP by administering low doses of vasopressors is possible after CA; noradrenaline is the usual first‐line vasopressor 7–8,9 . Vasopressors may have adverse effects, including cardiac arrhythmias and increased myocardial oxygen consumption that can result in ischaemia and afterload elevation 10 .…”

Section: Introductionmentioning

confidence: 99%

Protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest

Skrifvars

Ameloot

Grand

et al. 2022

Acta Anaesthesiol Scand

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Background: Hypotension is common after cardiac arrest (CA), and current guidelines recommend using vasopressors to target mean arterial blood pressure (MAP) higher than 65 mmHg. Pilot trials have compared higher and lower MAP targets. We will review the evidence on whether higher MAP improves outcome after cardiac arrest.Methods: This systematic review and meta-analysis will be conducted based on a systematic search of relevant major medical databases from their inception onwards,

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Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock

Cited by 28 publications

References 49 publications

Paramedic Practice in England with Adrenaline Following Return Of Spontaneous Circulation (ROSC)

Paramedic Practice in England with Adrenaline Following Return Of Spontaneous Circulation (ROSC)

Journal update monthly top five

Protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest

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