Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest: prognostic implications

John Bro-Jeppesen, Jesper Kjaergaard, Helle Søholm, Michael Wanscher, Freddy K Lippert, Jacob E Møller, Lars Køber, Christian Hassager

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopressor support and mortality.

METHODS: In a 6-year period, 310 comatose OHCA patients treated with TH were included. Temperature, hemodynamic parameters and level of vasopressors were registered from admission to 24h after rewarming. Level of vasopressor support was assessed by the cardiovascular sub-score of Sequential Organ Failure Assessment (SOFA). The population was stratified by use of dopamine as first line intervention (D-group) or use of dopamine+norepinephrine/epinephrine (DA-group). Primary endpoint was 30-day mortality and secondary endpoint was in-hospital cause of death.

RESULTS: Patients in the DA-group carried a 49% all-cause 30-day mortality rate compared to 23% in the D-group, plog-rank<0.0001, corresponding to an adjusted hazard ratio (HR) of 2.0 (95% CI: 1.3-3.0), p=0.001). The DA-group had an increased 30-day mortality due to neurological injury (HR=1.7 (95% CI: 1.1-2.7), p=0.02). Cause of death was anoxic brain injury in 78%, cardiovascular failure in 18% and multi-organ failure in 4%. The hemodynamic changes of TH reversed at normothermia, although the requirement for vasopressor support (cardiovascular SOFA≥3) persisted in 80% of patients.

CONCLUSIONS: In survivors after OHCA treated with TH the induced hemodynamic changes reversed after normothermia, while the need for vasopressor support persisted. Patients requiring addition of norepinephrine/epinephrine on top of dopamine had an increased 30-day all-cause mortality, as well as death from neurological injury.

Original languageEnglish
JournalResuscitation
Volume85
Issue number5
Pages (from-to)664-670
ISSN0300-9572
DOIs
Publication statusPublished - 2014

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Cause of Death
Rewarming
Wounds and Injuries
Survivors
Perfusion
Population

Cite this

Bro-Jeppesen, John ; Kjaergaard, Jesper ; Søholm, Helle ; Wanscher, Michael ; Lippert, Freddy K ; Møller, Jacob E ; Køber, Lars ; Hassager, Christian. / Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest : prognostic implications. In: Resuscitation. 2014 ; Vol. 85, No. 5. pp. 664-670.
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title = "Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest: prognostic implications",
abstract = "AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopressor support and mortality.METHODS: In a 6-year period, 310 comatose OHCA patients treated with TH were included. Temperature, hemodynamic parameters and level of vasopressors were registered from admission to 24h after rewarming. Level of vasopressor support was assessed by the cardiovascular sub-score of Sequential Organ Failure Assessment (SOFA). The population was stratified by use of dopamine as first line intervention (D-group) or use of dopamine+norepinephrine/epinephrine (DA-group). Primary endpoint was 30-day mortality and secondary endpoint was in-hospital cause of death.RESULTS: Patients in the DA-group carried a 49{\%} all-cause 30-day mortality rate compared to 23{\%} in the D-group, plog-rank<0.0001, corresponding to an adjusted hazard ratio (HR) of 2.0 (95{\%} CI: 1.3-3.0), p=0.001). The DA-group had an increased 30-day mortality due to neurological injury (HR=1.7 (95{\%} CI: 1.1-2.7), p=0.02). Cause of death was anoxic brain injury in 78{\%}, cardiovascular failure in 18{\%} and multi-organ failure in 4{\%}. The hemodynamic changes of TH reversed at normothermia, although the requirement for vasopressor support (cardiovascular SOFA≥3) persisted in 80{\%} of patients.CONCLUSIONS: In survivors after OHCA treated with TH the induced hemodynamic changes reversed after normothermia, while the need for vasopressor support persisted. Patients requiring addition of norepinephrine/epinephrine on top of dopamine had an increased 30-day all-cause mortality, as well as death from neurological injury.",
author = "John Bro-Jeppesen and Jesper Kjaergaard and Helle S{\o}holm and Michael Wanscher and Lippert, {Freddy K} and M{\o}ller, {Jacob E} and Lars K{\o}ber and Christian Hassager",
note = "Copyright {\circledC} 2014 Elsevier Ireland Ltd. All rights reserved.",
year = "2014",
doi = "10.1016/j.resuscitation.2013.12.031",
language = "English",
volume = "85",
pages = "664--670",
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Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest : prognostic implications. / Bro-Jeppesen, John; Kjaergaard, Jesper; Søholm, Helle; Wanscher, Michael; Lippert, Freddy K; Møller, Jacob E; Køber, Lars; Hassager, Christian.

In: Resuscitation, Vol. 85, No. 5, 2014, p. 664-670.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest

T2 - prognostic implications

AU - Bro-Jeppesen, John

AU - Kjaergaard, Jesper

AU - Søholm, Helle

AU - Wanscher, Michael

AU - Lippert, Freddy K

AU - Møller, Jacob E

AU - Køber, Lars

AU - Hassager, Christian

N1 - Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

PY - 2014

Y1 - 2014

N2 - AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopressor support and mortality.METHODS: In a 6-year period, 310 comatose OHCA patients treated with TH were included. Temperature, hemodynamic parameters and level of vasopressors were registered from admission to 24h after rewarming. Level of vasopressor support was assessed by the cardiovascular sub-score of Sequential Organ Failure Assessment (SOFA). The population was stratified by use of dopamine as first line intervention (D-group) or use of dopamine+norepinephrine/epinephrine (DA-group). Primary endpoint was 30-day mortality and secondary endpoint was in-hospital cause of death.RESULTS: Patients in the DA-group carried a 49% all-cause 30-day mortality rate compared to 23% in the D-group, plog-rank<0.0001, corresponding to an adjusted hazard ratio (HR) of 2.0 (95% CI: 1.3-3.0), p=0.001). The DA-group had an increased 30-day mortality due to neurological injury (HR=1.7 (95% CI: 1.1-2.7), p=0.02). Cause of death was anoxic brain injury in 78%, cardiovascular failure in 18% and multi-organ failure in 4%. The hemodynamic changes of TH reversed at normothermia, although the requirement for vasopressor support (cardiovascular SOFA≥3) persisted in 80% of patients.CONCLUSIONS: In survivors after OHCA treated with TH the induced hemodynamic changes reversed after normothermia, while the need for vasopressor support persisted. Patients requiring addition of norepinephrine/epinephrine on top of dopamine had an increased 30-day all-cause mortality, as well as death from neurological injury.

AB - AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopressor support and mortality.METHODS: In a 6-year period, 310 comatose OHCA patients treated with TH were included. Temperature, hemodynamic parameters and level of vasopressors were registered from admission to 24h after rewarming. Level of vasopressor support was assessed by the cardiovascular sub-score of Sequential Organ Failure Assessment (SOFA). The population was stratified by use of dopamine as first line intervention (D-group) or use of dopamine+norepinephrine/epinephrine (DA-group). Primary endpoint was 30-day mortality and secondary endpoint was in-hospital cause of death.RESULTS: Patients in the DA-group carried a 49% all-cause 30-day mortality rate compared to 23% in the D-group, plog-rank<0.0001, corresponding to an adjusted hazard ratio (HR) of 2.0 (95% CI: 1.3-3.0), p=0.001). The DA-group had an increased 30-day mortality due to neurological injury (HR=1.7 (95% CI: 1.1-2.7), p=0.02). Cause of death was anoxic brain injury in 78%, cardiovascular failure in 18% and multi-organ failure in 4%. The hemodynamic changes of TH reversed at normothermia, although the requirement for vasopressor support (cardiovascular SOFA≥3) persisted in 80% of patients.CONCLUSIONS: In survivors after OHCA treated with TH the induced hemodynamic changes reversed after normothermia, while the need for vasopressor support persisted. Patients requiring addition of norepinephrine/epinephrine on top of dopamine had an increased 30-day all-cause mortality, as well as death from neurological injury.

U2 - 10.1016/j.resuscitation.2013.12.031

DO - 10.1016/j.resuscitation.2013.12.031

M3 - Journal article

C2 - 24412644

VL - 85

SP - 664

EP - 670

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

IS - 5

ER -