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<p>There is insufficient evidence regarding the use of second-line vasopressors following norepinephrine administration in the post-resuscitation management of patients with out-of-hospital cardiac arrest (OHCA). Therefore, this study aimed to investigate the survival outcomes between norepinephrine plus epinephrine and norepinephrine plus vasopressin as vasopressor combinations after return of spontaneous circulation (ROSC) in patients with OHCA. This retrospective observational study included data from a prospective multicenter registry. Adult patients with OHCA who achieved sustained ROSC and received vasopressor combinations of norepinephrine plus epinephrine or norepinephrine plus vasopressin were included in the study. The variable of interest was the vasopressor combination either norepinephrine plus epinephrine or norepinephrine plus vasopressin within 24&#xa0;h from sustained ROSC. The primary outcome was survival to discharge. Multivariable logistic regression analysis was conducted. Between October 2015 and June 2024, 901 patients were analyzed. Survival to discharge and good neurological outcome were significantly higher in the group with norepinephrine plus epinephrine than in the group with norepinephrine plus vasopressin (17.0% vs. 9.1%, p = 0.001, and 8.1% vs. 3.2%, p = 0.002, respectively). Norepinephrine plus vasopressin was independently associated with worse survival to discharge and neurological outcome compared to norepinephrine plus epinephrine, after adjusting for potential confounders (adjusted odds ratio [aOR] 0.454, 95% confidence interval [CI] 0.277–0.746, p = 0.002 and aOR 0.346, 95% CI 0.150–0.794, p = 0.012, respectively). These findings were maintained in multiple regression models and sensitivity analyses. Norepinephrine plus epinephrine administration within 24&#xa0;h from sustained ROSC showed better survival to discharge than norepinephrine plus vasopressin in patients with OHCA.</p>

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Comparison between norepinephrine plus epinephrine and norepinephrine plus vasopressin after return of spontaneous circulation in patients with out-of-hospital cardiac arrest

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月18日

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  • Sejoong Ahn,
  • Bo-Yeong Jin,
  • Sukyo Lee,
  • Jong-Hak Park,
  • Hanjin Cho,
  • Sungwoo Moon,
  • Sang Kuk Han,
  • Phil Cho Choi,
  • Young Hwan Lee,
  • Sang O. Park,
  • Jong Seok Lee,
  • Ki Young Jeong,
  • Sung Hyuk Choi,
  • Young Hoon Yoon,
  • Su Jin Kim,
  • Kap Su Han,
  • Min Seob Sim,
  • Gun Tak Lee,
  • Youn Jung Kim,
  • Jong Whan Shin,
  • Hui Jai Lee,
  • Keun Hong Park,
  • Hahn Bom Kim,
  • Yoo Seok Park,
  • Arom Choi,
  • Tae Young Kong,
  • Hyuna Hwang,
  • Youngsuk Cho,
  • Gu Hyun Kang,
  • Yong Soo Jang,
  • Jae Hoon Oh,
  • Jun Cheol Lee,
  • Sung Wook Park,
  • Wook Tae Yang,
  • Hyun Wook Ryu,
  • Jae Yun Ahn,
  • Hyuk Jun Yang,
  • Jae-hyug Woo,
  • Sung Hyun Yun,
  • Chong Sun Kim,
  • Sun Pyo Kim,
  • Jin Woong Lee,
  • Wonjoon Jeong,
  • Sung Soo Park,
  • Jae Kwang Lee,
  • Ryeok Ahn,
  • Wook Jin Choi,
  • Bang Shill Rhee,
  • You Hwan Jo,
  • Sung Min Park,
  • In Byung Kim,
  • Ki Ok Ahn,
  • Seung Cheol Lee,
  • Sang Hun Lee,
  • Kyeong Min Lee,
  • Young Sik Kim,
  • Jin Sik Park,
  • Myung Hee Park,
  • Dai Han Wi,
  • Jin Kun Bae,
  • Yong Hee Lee,
  • Sang Ook Ha,
  • Won Seok Yang,
  • Ju Ok Park,
  • Hang A. Park,
  • Kyoung Chul Cha,
  • Woo Jin Jung,
  • Taek Geun Ohk,
  • Myoung Cheol Shin,
  • An Mu Eob,
  • Kyung Sook Park,
  • Sang Chul Kim,
  • Gwan Jin Park,
  • Han Joo Choi,
  • Yong Oh Kim,
  • Tae Oh Jung,
  • Jae Chol Yoon,
  • Young Tae Park,
  • Ju Taek Lee,
  • Jin Hee Jeong,
  • Sang Bong Lee,
  • Won Kim,
  • Yi Sang Moon,
  • Sung Wook Song,
  • Seo Young Ko,
  • Joon-myoung Kwon,
  • Eui Hyuk Kang,
  • Sang Chan Jin,
  • Tae-kwon Kim,
  • Chang Sun Kim,
  • Hyun Goo Shin,
  • Dong Sun Choi,
  • Chul Min Ha,
  • Jai Woog Ko,
  • Yun Jeong Hwang,
  • Sung Phil Chung,
  • Kyung Jun Song,
  • Sang Hoon Na,
  • Gyu Chong Cho,
  • Seung Sik Hwang,
  • Sung Oh Hwang,
  • Sang Do Shin,
  • Jeong Ho Park,
  • Won Young Kim,
  • Jin Hee Jung,
  • Ji Hoon Kim

摘要

There is insufficient evidence regarding the use of second-line vasopressors following norepinephrine administration in the post-resuscitation management of patients with out-of-hospital cardiac arrest (OHCA). Therefore, this study aimed to investigate the survival outcomes between norepinephrine plus epinephrine and norepinephrine plus vasopressin as vasopressor combinations after return of spontaneous circulation (ROSC) in patients with OHCA. This retrospective observational study included data from a prospective multicenter registry. Adult patients with OHCA who achieved sustained ROSC and received vasopressor combinations of norepinephrine plus epinephrine or norepinephrine plus vasopressin were included in the study. The variable of interest was the vasopressor combination either norepinephrine plus epinephrine or norepinephrine plus vasopressin within 24 h from sustained ROSC. The primary outcome was survival to discharge. Multivariable logistic regression analysis was conducted. Between October 2015 and June 2024, 901 patients were analyzed. Survival to discharge and good neurological outcome were significantly higher in the group with norepinephrine plus epinephrine than in the group with norepinephrine plus vasopressin (17.0% vs. 9.1%, p = 0.001, and 8.1% vs. 3.2%, p = 0.002, respectively). Norepinephrine plus vasopressin was independently associated with worse survival to discharge and neurological outcome compared to norepinephrine plus epinephrine, after adjusting for potential confounders (adjusted odds ratio [aOR] 0.454, 95% confidence interval [CI] 0.277–0.746, p = 0.002 and aOR 0.346, 95% CI 0.150–0.794, p = 0.012, respectively). These findings were maintained in multiple regression models and sensitivity analyses. Norepinephrine plus epinephrine administration within 24 h from sustained ROSC showed better survival to discharge than norepinephrine plus vasopressin in patients with OHCA.