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@article{1359739,
author = {Tarvasmaki, T. and Lassus, J. and Varpula, M. and Sionis, A. and Sund, R. and Kober, L. and Špinar, Jindřich and Parissis, J. and Banaszewski, M. and Cardoso, J. S. and Carubelli, V. and Di Somma, S. and Mebazaa, A. and Harjola, V.P.},
article_location = {LONDON},
article_number = {208},
doi = {http://dx.doi.org/10.1186/s13054-016-1387-1},
keywords = {Cardiogenic shock; Vasoactive medication; Vasopressors; Inotropes; Adrenaline; Mortality; Survival; Propensity score},
language = {eng},
issn = {1466-609X},
journal = {Critical Care},
title = {Current real-life use of vasopressors and inotropes in cardiogenic shock - adrenaline use is associated with excess organ injury and mortality},
volume = {20},
year = {2016}
}
TY - JOUR
ID - 1359739
AU - Tarvasmaki, T. - Lassus, J. - Varpula, M. - Sionis, A. - Sund, R. - Kober, L. - Špinar, Jindřich - Parissis, J. - Banaszewski, M. - Cardoso, J. S. - Carubelli, V. - Di Somma, S. - Mebazaa, A. - Harjola, V.P.
PY - 2016
TI - Current real-life use of vasopressors and inotropes in cardiogenic shock - adrenaline use is associated with excess organ injury and mortality
JF - Critical Care
VL - 20
IS - 208
SP - 1-11
EP - 1-11
PB - BioMed Central
SN - 1466609X
KW - Cardiogenic shock
KW - Vasoactive medication
KW - Vasopressors
KW - Inotropes
KW - Adrenaline
KW - Mortality
KW - Survival
KW - Propensity score
N2 - Background: Vasopressors and inotropes remain a cornerstone in stabilization of the severely impaired hemodynamics and cardiac output in cardiogenic shock (CS). The aim of this study was to analyze current real-life use of these medications, and their impact on outcome and on changes in cardiac and renal biomarkers over time in CS. Methods: The multinational CardShock study prospectively enrolled 219 patients with CS. The use of vasopressors and inotropes was analyzed in relation to the primary outcome, i.e., 90-day mortality, with propensity score methods in 216 patients with follow-up data available. Changes in cardiac and renal biomarkers over time until 96 hours from baseline were analyzed with linear mixed modeling. Results: Patients were 67 (SD 12) years old, 26 % were women, and 28 % had been resuscitated from cardiac arrest prior to inclusion. On average, systolic blood pressure was 78 (14) and mean arterial pressure 57 (11) mmHg at detection of shock. 90-day mortality was 41 %. Vasopressors and/or inotropes were administered to 94 % of patients and initiated principally within the first 24 hours. Noradrenaline and adrenaline were given to 75 % and 21 % of patients, and 30 % received several vasopressors. In multivariable logistic regression, only adrenaline (21 %) was independently associated with increased 90-day mortality (OR 5.2, 95 % CI 1.88, 14.7, p = 0.002). The result was independent of prior cardiac arrest (39 % of patients treated with adrenaline), and the association remained in propensity-score-adjusted analysis among vasopressor-treated patients (OR 3.0, 95 % CI 1.3, 7.2, p = 0.013); this was further confirmed by propensity-score-matched analysis. Adrenaline was also associated, independent of prior cardiac arrest, with marked worsening of cardiac and renal biomarkers during the first days. Dobutamine and levosimendan were the most commonly used inotropes (49 % and 24 %). There were no differences in mortality, whether noradrenaline was combined with dobutamine or levosimendan. Conclusion: Among vasopressors and inotropes, adrenaline was independently associated with 90-day mortality in CS. Moreover, adrenaline use was associated with marked worsening in cardiac and renal biomarkers. The combined use of noradrenaline with either dobutamine or levosimendan appeared prognostically similar.
ER -
TARVASMAKI, T., J. LASSUS, M. VARPULA, A. SIONIS, R. SUND, L. KOBER, Jindřich ŠPINAR, J. PARISSIS, M. BANASZEWSKI, J. S. CARDOSO, V. CARUBELLI, S. DI SOMMA, A. MEBAZAA and V.P. HARJOLA. Current real-life use of vasopressors and inotropes in cardiogenic shock - adrenaline use is associated with excess organ injury and mortality. \textit{Critical Care}. LONDON: BioMed Central, 2016, vol.~20, No~208, p.~1-11. ISSN~1466-609X. Available from: https://dx.doi.org/10.1186/s13054-016-1387-1.
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