Norepinephrine versus epinephrine for hemodynamic support in post-cardiac arrest shock: A systematic review.
Am J Emerg Med
; 77: 158-163, 2024 Mar.
Article
en En
| MEDLINE
| ID: mdl-38150986
ABSTRACT
PURPOSE:
The preferred vasopressor in post-cardiac arrest shock has not been established with robust clinical outcomes data. Our goal was to perform a systematic review and meta-analysis comparing rates of in-hospital mortality, refractory shock, and hemodynamic parameters in post-cardiac arrest patients who received either norepinephrine or epinephrine as primary vasopressor support.METHODS:
We conducted a search of PubMed, Cochrane Library, and CINAHL from 2000 to 2022. Included studies were prospective, retrospective, or published abstracts comparing norepinephrine and epinephrine in adults with post-cardiac arrest shock or with cardiogenic shock and extractable post-cardiac arrest data. The primary outcome of interest was in-hospital mortality. Other outcomes included incidence of arrhythmias or refractory shock.RESULTS:
The database search returned 2646 studies. Two studies involving 853 participants were included in the systematic review. The proposed meta-analysis was deferred due to low yield. Crude incidence of in-hospital mortality was numerically higher in the epinephrine group compared with norepinephrine in both studies, but only statistically significant in one. Risk of bias was moderate to severe for in-hospital mortality. Additional outcomes were reported differently between studies, minimizing direct comparison.CONCLUSION:
The vasopressor with the best mortality and hemodynamic outcomes in post-cardiac arrest shock remains unclear. Randomized studies are crucial to remedy this.Palabras clave
Texto completo:
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Base de datos:
MEDLINE
Asunto principal:
Choque
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Paro Cardíaco
Tipo de estudio:
Systematic_reviews
Límite:
Adult
/
Humans
Idioma:
En
Revista:
Am J Emerg Med
Año:
2024
Tipo del documento:
Article