Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin.
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Emerg Med. 2023 Sep;65(3):e209-e220. doi: 10.1016/j.jemermed.2023.05.002. Epub 2023 Jun 3.
Cardiac arrest occurs in approximately 350,000 patients outside the hospital and approximately 30,000 patients in the emergency department (ED) annually in the United States. When return of spontaneous circulation (ROSC) is achieved, hypotension is a common complication. However, optimal dosing of vasopressors is not clear.
The objective of this study was to determine if initial vasopressor dosing was associated with cardiac re-arrest in patients after ROSC.
This was a retrospective, single-center analysis of adult patients experiencing cardiac arrest prior to arrival or within the ED. Patients were assigned to one of four groups based on starting dose of vasopressor: low dose (LD; < 0.25 µg/kg/min), medium dose (MD; 0.25-0.49 µg/kg/min), high dose (HD; 0.5-0.99 µg/kg/min), and very high dose (VHD; ≥ 1 µg/kg/min). Data collection was performed primarily via manual chart review of medical records. The primary outcome was incidence of cardiac re-arrest within 1 h of vasopressor initiation. Multivariate logistic regression analysis was conducted to identify any covariates strongly associated with the primary outcome.
No difference in cardiac re-arrest incidence was noted between groups. The VHD group was significantly more likely to require a second vasopressor (p = 0.003). The HD group had lower survival rates to hospital discharge compared with the LD and MD groups (p = 0.0033 and p = 0.0147). In the multivariate regression, longer duration of pre-vasopressor re-arrests and hyperkalemic cardiac arrest etiology were significant predictors of cardiac re-arrest after vasopressor initiation.
Initial vasopressor dosing was not found to be associated with risk of cardiac re-arrest or, conversely, risk of adverse events.
在美国，每年约有 35 万名院外和 3 万名急诊科（ED）患者发生心脏骤停。当自主循环恢复（ROSC）时，低血压是常见的并发症。然而，血管加压剂的最佳剂量尚不清楚。
本研究旨在确定 ROSC 后患者的初始血管加压剂剂量是否与心脏再停搏有关。
这是一项回顾性的、单中心分析，纳入在到达 ED 之前或在 ED 内经历心脏骤停的成年患者。根据起始血管加压剂剂量将患者分为四组：低剂量（LD；<0.25μg/kg/min）、中剂量（MD；0.25-0.49μg/kg/min）、高剂量（HD；0.5-0.99μg/kg/min）和超高剂量（VHD；≥1μg/kg/min）。数据主要通过手动查阅病历进行收集。主要结局是血管加压剂起始后 1 小时内心脏再停搏的发生率。采用多变量逻辑回归分析确定与主要结局强烈相关的任何协变量。
各组间心脏再停搏发生率无差异。VHD 组更有可能需要第二种血管加压剂（p=0.003）。与 LD 和 MD 组相比，HD 组的存活率更低（p=0.0033 和 p=0.0147）。在多变量回归中，血管加压剂前再停搏时间较长和高钾血症性心脏骤停病因是血管加压剂起始后心脏再停搏的显著预测因素。
初始血管加压剂剂量与心脏再停搏风险或相反的不良事件风险无关。
