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Article Dans Une Revue Intensive Care Medicine Année : 2018

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

1 Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière]
2 BioCANVAS / U942 - Biomarqueurs CArdioNeuroVASCulaires
3 Service d'Anesthésie et Soins Intensifs [HEGP]
4 University Hospital Brno
5 MUNI - Masaryk University [Brno]
6 Helsingin yliopisto = Helsingfors universitet = University of Helsinki
7 Helsinki University Eye Hospital
8 Heart and Lung Center [Helsinki]
9 Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion]
10 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
11 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
12 Hôpital de la Tour
13 Austin Hospital [Melbourne]
14 ANZIC RC - Australian and New Zealand Intensive Care Research Centre
15 School of Medicine [University of Melbourne]
16 The Royal Melbourne Hospital
17 UMC - University Medicine Cluster
18 Service de Cardiologie [CHRU Nancy]
19 AMC Heart Center
20 TU Dresden - Technische Universität Dresden = Dresden University of Technology
21 Praxisklinik Herz und Gefaesse
22 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
23 Service de Soins Intensifs [CHRU Nancy]
24 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
25 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
26 Henry Ford Hospital
27 UKC Maribor - University medical centre Maribor
28 Universität zu Köln = University of Cologne
29 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
30 Service d’Accueil des urgences [CHRU Nancy]
Philip Urban
  • Fonction : Auteur
Batric Popovic
Dagmar Ouweneel
  • Fonction : Auteur
José Henriques
  • Fonction : Auteur

Résumé

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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Dates et versions

hal-01809259 , version 1 (01-05-2020)

Identifiants

Citer

Valentine Léopold, Etienne Gayat, Romain Pirracchio, Jindrich Spinar, Jiri Parenica, et al.. Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients. Intensive Care Medicine, In press, 44 (6), pp.847-856. ⟨10.1007/s00134-018-5222-9⟩. ⟨hal-01809259⟩
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