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01-06-2018 | Systematic Review

Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients

Authors: Valentine Léopold, Etienne Gayat, Romain Pirracchio, Jindrich Spinar, Jiri Parenica, Tuukka Tarvasmäki, Johan Lassus, Veli-Pekka Harjola, Sébastien Champion, Faiez Zannad, Serafina Valente, Philip Urban, Horng-Ruey Chua, Rinaldo Bellomo, Batric Popovic, Dagmar M. Ouweneel, José P. S. Henriques, Gregor Simonis, Bruno Lévy, Antoine Kimmoun, Philippe Gaudard, Mir Babar Basir, Andrej Markota, Christoph Adler, Hannes Reuter, Alexandre Mebazaa, Tahar Chouihed

Published in: Intensive Care Medicine | Issue 6/2018

Abstract

Objective

Catecholamines have been the mainstay of pharmacological treatment of cardiogenic shock (CS). Recently, use of epinephrine has been associated with detrimental outcomes. In the present study we aimed to evaluate the association between epinephrine use and short-term mortality in all-cause CS patients.

Design

We performed a meta-analysis of individual data with prespecified inclusion criteria: (1) patients in non-surgical CS treated with inotropes and/or vasopressors and (2) at least 15% of patients treated with epinephrine administrated alone or in association with other inotropes/vasopressors. The primary outcome was short-term mortality.

Measurements and results

Fourteen published cohorts and two unpublished data sets were included. We studied 2583 patients. Across all cohorts of patients, the incidence of epinephrine use was 37% (17–76%) and short-term mortality rate was 49% (21–69%). A positive correlation was found between percentages of epinephrine use and short-term mortality in the CS cohort. The risk of death was higher in epinephrine-treated CS patients (OR [CI] = 3.3 [2.8–3.9]) compared to patients treated with other drug regimens. Adjusted mortality risk remained striking in epinephrine-treated patients (n = 1227) (adjusted OR = 4.7 [3.4–6.4]). After propensity score matching, two sets of 338 matched patients were identified and epinephrine use remained associated with a strong detrimental impact on short-term mortality (OR = 4.2 [3.0–6.0]).

Conclusions

In this very large cohort, epinephrine use for hemodynamic management of CS patients is associated with a threefold increase of risk of death.

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Title: Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients
Authors: Valentine Léopold
Etienne Gayat
Romain Pirracchio
Jindrich Spinar
Jiri Parenica
Tuukka Tarvasmäki
Johan Lassus
Veli-Pekka Harjola
Sébastien Champion
Faiez Zannad
Serafina Valente
Philip Urban
Horng-Ruey Chua
Rinaldo Bellomo
Batric Popovic
Dagmar M. Ouweneel
José P. S. Henriques
Gregor Simonis
Bruno Lévy
Antoine Kimmoun
Philippe Gaudard
Mir Babar Basir
Andrej Markota
Christoph Adler
Hannes Reuter
Alexandre Mebazaa
Tahar Chouihed
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 6/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5222-9

At a glance: The STEP trials

Springer Medicine

Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients

Abstract

Objective

Design

Measurements and results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design

Measurements and results

Conclusions

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