The following is a summary of “Lack of Association of Initial Vasopressor Dosing with Survival and Cardiac Re-Arrest Likelihood After Return of Spontaneous Circulation,” published in the September 2023 issue of Emergency Medicine by Sharpe, et al.
About 30,000 people in the United States go into cardiac arrest every year in the emergency department (ED), while another 350,000 people have a cardiac arrest outside of a hospital. Hypotension is a typical side effect of return spontaneous circulation (ROSC). However, the most effective dose of vasopressors has yet to be determined.
The purpose of this research was to see whether the first dose of vasopressors given to patients following ROSC was linked to cardiac re-arrest. Adult patients who had cardiac arrest either before they were taken to the ED or while they were there were analyzed retrospectively. Based on the initial vasopressor dosage, patients were divided into 4 groups: low dose (LD; < 0.25 µg/kg/min), medium dose (MD; 0.25–0.49 µg/kg/min), high dose (HD; 0.5–0.99 µg/kg/min), and very high dose (VHD; ≥ 1 µg/kg/min). Data gathering was mostly accomplished through manual recordkeeping. After 1 hour after starting vasopressors, the rate of cardiac re-arrest was the major measure of success. Covariates substantially linked to the main outcome were identified using multivariate logistic regression.
No difference in cardiac re-arrest incidence was detected between groups. The VHD group was considerably more likely to need a second vasopressor (p = 0.003). Survival rates after hospital release were significantly lower in the HD group compared to the LD and MD groups (p = 0.0033 and p = 0.0147, respectively). Longer pre-vasopressor re-arrest durations and hyperkalemic cardiac arrest etiology were significant predictors of cardiac re-arrest after vasopressor commencement in the multivariate regression. Initial vasopressor dose was not shown to be linked with risk of cardiac re-arrest or, conversely, risk of adverse events.
Source: sciencedirect.com/science/article/abs/pii/S0736467923003001
