دورية أكاديمية
أعرض في EDS

Cumulative epinephrine dose during cardiac arrest and neurologic outcome after extracorporeal cardiopulmonary resuscitation.

التفاصيل البيبلوغرافية
العنوان: Cumulative epinephrine dose during cardiac arrest and neurologic outcome after extracorporeal cardiopulmonary resuscitation.
المؤلفون: Garcia SI; Department of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address: garcia.samuel@mayo.edu., Seelhammer TG; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address: seelhammer.troy@mayo.edu., Saddoughi SA; Division of Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Department of Cardiovascular Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address: saddoughi.sahar-al-sadat@mayo.edu., Finch AS; Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address: finch.alexander@mayo.edu., Park JG; Department of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address: park.john@mayo.edu., Wieruszewski PM; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Department of Pharmacy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address: wieruszewski.patrick@mayo.edu.
المصدر: The American journal of emergency medicine [Am J Emerg Med] 2024 Jun; Vol. 80, pp. 61-66. Date of Electronic Publication: 2024 Mar 15.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: W B Saunders Country of Publication: United States NLM ID: 8309942 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8171 (Electronic) Linking ISSN: 07356757 NLM ISO Abbreviation: Am J Emerg Med Subsets: MEDLINE
أسماء مطبوعة: Publication: 1983- : Philadelphia, PA : W B Saunders
Original Publication: [Philadelphia, PA. : Centrum Philadelphia, c1983]-
مواضيع طبية MeSH: Epinephrine*/administration & dosage , Cardiopulmonary Resuscitation*/methods , Extracorporeal Membrane Oxygenation*/methods , Heart Arrest*/therapy, Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Vasoconstrictor Agents/administration & dosage ; Vasoconstrictor Agents/therapeutic use ; Adult ; Dose-Response Relationship, Drug ; Treatment Outcome
مستخلص: Background: Epinephrine is recommended without an apparent ceiling dosage during cardiac arrest. However, excessive alpha- and beta-adrenergic stimulation may contribute to unnecessarily high aortic afterload, promote post-arrest myocardial dysfunction, and result in cerebral microvascular insufficiency in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR).
Methods: This was a retrospective cohort study of adults (≥ 18 years) who received ECPR at large academic ECMO center from 2018 to 2022. Patients were grouped based on the amount of epinephrine given during cardiac arrest into low (≤ 3 mg) and high (> 3 mg) groups. The primary endpoint was neurologic outcome at hospital discharge, defined by cerebral performance category (CPC). Multivariable logistic regression was used to assess the relationship between cumulative epinephrine dosage during arrest and neurologic outcome.
Results: Among 51 included ECPR cases, the median age of patients was 60 years, and 55% were male. The mean cumulative epinephrine dose administered during arrest was 6.2 mg but ranged from 0 to 24 mg. There were 18 patients in the low-dose (≤ 3 mg) and 25 patients in the high-dose (> 3 mg) epinephrine groups. Favorable neurologic outcome at discharge was significantly greater in the low-dose (55%) compared to the high-dose (24%) group (p = 0.025). After adjusting for age, those who received higher doses of epinephrine during the arrest were more likely to have unfavorable neurologic outcomes at hospital discharge (odds ratio 4.6, 95% CI 1.3, 18.0, p = 0.017).
Conclusion: After adjusting for age, cumulative epinephrine doses above 3 mg during cardiac arrest may be associated with unfavorable neurologic outcomes after ECPR and require further investigation.
Competing Interests: Declaration of competing interest The authors of the manuscript titled “Cumulative Epinephrine Dose during Cardiac Arrest and Neurologic Outcome after Extracorporeal Cardiopulmonary Resuscitation” submitted to “The American Journal of Emergency Medicine,” affirm that we have no conflicts of interest to declare. There are no financial interests or personal/professional relationships that could reasonably be perceived as influencing the integrity or objectivity of the research presented in this manuscript. We understand the importance of transparency in maintaining the credibility of scientific publications and commit to promptly notify the editorial board of “The American Journal of Emergency Medicine” should any conflicts of interest arise post-submission.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
فهرسة مساهمة: Keywords: Cardiac arrest; Epinephrine; Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; Favorable neurologic outcome
المشرفين على المادة: YKH834O4BH (Epinephrine)
0 (Vasoconstrictor Agents)
تواريخ الأحداث: Date Created: 20240320 Date Completed: 20240529 Latest Revision: 20240531
رمز التحديث: 20240601
DOI: 10.1016/j.ajem.2024.03.013
PMID: 38507848
قاعدة البيانات: MEDLINE
الوصف
تدمد:1532-8171
DOI:10.1016/j.ajem.2024.03.013