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The following is a summary of “Risk of arrhythmia in post-resuscitative shock after out-of-hospital cardiac arrest with epinephrine versus norepinephrine,” published in the March 2024 issue of Emergency Medicine by Normand, et al.

For a study, researchers sought to determine the rates of clinically significant tachyarrhythmias and mortality in the management of post-resuscitative shock after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) who receive continuous epinephrine versus norepinephrine infusion.

Adult patients were admitted for OHCA with post-resuscitative shock managed with either epinephrine or norepinephrine infusions within 6 hours of ROSC. Between May 5th, 2018, and January 31st, 2022, 221 patients admitted for OHCA received post-resuscitative epinephrine or norepinephrine infusions. There was no difference in the rate of tachyarrhythmias between epinephrine and norepinephrine infusion in univariate (47.1% vs 41.7%, OR 1.24, 95% CI 0.71–2.20) or multivariable analysis (OR 1.34, 95% CI 0.68–2.62). Patients treated with epinephrine were more likely to die during hospitalization than those treated with norepinephrine (90.0% vs 54.3%, OR 6.21, 95% CI 2.37–16.25, P < 0.001). Epinephrine-treated patients were also more likely to experience re-arrest during hospital admission (55.7% vs 14.6%, OR 5.77, 95% CI 2.74–12.18, P < 0.001).

There was no statistically significant difference in clinically significant cardiac tachyarrhythmias in patients post-OHCA treated with epinephrine versus norepinephrine infusions after ROSC. However, re-arrest rates and in-hospital mortality were higher in patients who received epinephrine infusions in the first 6 hours post-ROSC. The findings suggested norepinephrine may be the vasopressor of choice in patients post-OHCA with post-resuscitative shock after ROSC, adding to existing literature.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006812