(1402) Comparison of Epinephrine Versus Norepinephrine on Post-Cardiac Arrest Outcomes

Introduction: Post-resuscitation shock (PRS) may occur in 50 – 70% of patients who experience cardiac arrest, leading to multiple-organ failure and increased mortality. American Heart Association highlights the importance of hemodynamic support after achieving return of spontaneous circulation (ROSC) but provide no specific vasopressor recommendation. A study by Bougoin, et al. found epinephrine (EPI) infusion for PRS was associated with higher all-cause and cardiovascular-specific mortality, compared with norepinephrine (NE) infusion. The purpose of this study was to compare the use of EPI versus NE infusion for outside hospital cardiac arrest (OHCA) in terms of clinical outcomes, length of stay (LOS), and need for additional vasopressor support.

Methods: This Institutional Review Board approved, retrospective, single center study evaluated adult patients with OHCA who received EPI or NE continuous infusion for at least six hours. Patients were excluded for cardiac arrest secondary to noncardiac causes, refractory shock requiring extracorporeal membrane oxygenation, treatment with concurrent EPI and NE infusions, documented pregnancy and prisoners.

Results: One hundred four patients were included, with 62 patients in the NE group and 42 patients in the EPI group. Baseline characteristics between groups were well-matched, with the EPI group having a higher prevalence of congestive heart failure (13% vs. 17%, p-value=0.031). There was no statistical significance for survival to discharge (41% vs. 36%, p-value=0.258), recurrent cardiac arrest (21% vs. 12%, p-value=0.569), hospital LOS (8 vs. 11 days, p-value=0.263) and intensive care unit LOS (8 vs. 8 days, p-value=0.912). While there was no statistically significant difference for duration and max infusion rate of vasopressors, the NE group required less additional vasopressors despite lower systolic blood pressure and mean arterial pressure prior to infusion (52% vs. 10%, p-value= < 0.001).

Conclusions: For OHCA, use of EPI versus NE did not have statistically significant difference in survival to hospital discharge. Despite this, the NE group needed less additional vasopressor support than the EPI group. While additional studies are needed to confirm these findings, there may be benefit to utilizing NE instead of EPI for OHCA with post-resuscitation shock.