Association between dose of catecholamines and markers of organ injury early after out-of-hospital cardiac arrest.
Por:
Czerwinska-Jelonkiewicz K, Wood A, Bohm A, Kwasiborski P, Oleksiak A, Ryczek R, Grand J, Tavazzi G, Sionis A, Stepinska J
Publicada:
1 ene 2023
Ahead of Print:
28 dic 2021
Resumen:
BACKGROUND: Catecholamines are recommended as first-line drugs to treat hemodynamic instability after out-of-hospital cardiac arrest (OHCA). The benefit-to-risk ratio of catecholamines is dose dependent, however, their effect on metabolism and organ function early after OHCA has not been investigated. METHODS: The Post-Cardiac Arrest Syndrome (PCAS) pilot study was a prospective, observational, multicenter study. The primary outcomes of this analysis were association between norepinephrine/cumulative catecholamines doses and neuron specific enolase (NSE)/lactate concentration over the first 72 hours after resuscitation. The association was adjusted for proven OHCA mortality predictors and verified with propensity score matching (PSM). RESULTS: Overall 148 consecutive OHCA patients; aged 18-91 (62.9 ± 15.27), 41 (27.7%) being female, were included. Increasing norepinephrine and cumulative catecholamines doses were significantly associated with higher NSE concentration on admission (r = 0.477, p < 0.001; r = 0.418, p < 0.001) and at 24 hours after OHCA (r = 0.339, p < 0.01; r = 0.441, p < 0.001) as well as with higher lactate concentration on admission (r = 0.404, p < 0.001; r = 0.280, p < 0.01), at 24 hours (r = 0.476, p < 0.00; r = 0.487, p < 0.001) and 48 hours (r = 0.433, p < 0.01; r = 0.318, p = 0.01) after OHCA. The associations remained significant up to 48 hours in non-survivors after PSM. CONCLUSIONS: Increasing the dose of catecholamines is associated with higher lactate and NSE concentration, which may suggest their importance for tissue oxygen delivery, anaerobic metabolism, and organ function early after OHCA.
Filiaciones:
Czerwinska-Jelonkiewicz K:
Division of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.
Intensive Therapy Unit, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Wood A:
University Hospitals of Leicester, Leicester, United Kingdom
Bohm A:
Department of Acute Cardiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
Kwasiborski P:
Third Department of Internal Diseases and Cardiology, Warsaw Medical University, Warsaw, Poland
Oleksiak A:
Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland
Ryczek R:
Department of Cardiology, Military Institute of Medicine, Warsaw, Poland
Grand J:
Department of Cardiology, University Hospital of Copenhagen, Denmark
Tavazzi G:
Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
Sionis A:
Intensive Cardiac Care Unit Cardiology Department Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Stepinska J:
Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland
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