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Association between dose of catecholamines and markers of organ injury early after out-of-hospital cardiac arrest
, 3, 4, 5, 6, 7, 8, 9, 10, 6
Affiliations- 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
- University Hospitals of Leicester, United Kingdom
- Department of Acute Cardiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
- Third Department of Internal Diseases and Cardiology, Warsaw Medical University, Warsaw, Poland
- Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland
- Department of Cardiology, Military Institute of Medicine, Warsaw, Poland
- Department of Cardiology, University Hospital of Copenhagen, Denmark
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
- Intensive Cardiac Care Unit Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Abstract
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 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.
Abstract
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 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.
Keywords
catecholamines, cardiac arrest, out-of-hospital cardiac arrest, metabolism after cardiac arrest, organ failure after cardiac arrest
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About this articleTitle
Association between dose of catecholamines and markers of organ injury early after out-of-hospital cardiac arrest
Journal
Issue
Article type
Original Article
Pages
946-956
Published online
2021-12-28
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1593
Article views/downloads
499
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(6):946-956.
Keywords
catecholamines
cardiac arrest
out-of-hospital cardiac arrest
metabolism after cardiac arrest
organ failure after cardiac arrest
Authors
Katarzyna Czerwińska-Jelonkiewicz
Alice Wood
Allan Bohm
Przemysław Kwasiborski
Anna Oleksiak
Robert Ryczek
Johannes Grand
Guido Tavazzi
Alessandro Sionis
Janina Stępińska
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