Hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non-shockable rhythm: A post hoc analysis of a randomized controlled trial
Background: Patients admitted after cardiac arrest with non-shockable rhythm frequently experience hemodynamic instability. This study assessed the hemodynamic consequences of TTM in this sub population. Methods: This is a post hoc analysis of the HYPERION trial (NCT01994772), that randomized patien...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | Resuscitation Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520422000716 |
| _version_ | 1798033089522302976 |
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| author | Matthieu Petit Jean-Baptiste Lascarrou Gwenhael Colin Hamid Merdji Alain Cariou Guillaume Geri |
| author_facet | Matthieu Petit Jean-Baptiste Lascarrou Gwenhael Colin Hamid Merdji Alain Cariou Guillaume Geri |
| author_sort | Matthieu Petit |
| collection | DOAJ |
| description | Background: Patients admitted after cardiac arrest with non-shockable rhythm frequently experience hemodynamic instability. This study assessed the hemodynamic consequences of TTM in this sub population. Methods: This is a post hoc analysis of the HYPERION trial (NCT01994772), that randomized patients to either hypothermia or normothermia after non-shockable rhythm related cardiac arrest. Patients with no, moderate or severe circulatory failure were identified with cardiovascular Sequential Organ Failure Assessment at randomization. Primary outcome was the number of patients at day 7 with resolution of shock, accounting for the risk of death (competing risk analysis). Secondary endpoint included neurological outcome and death at day-90. Results: 584 patients were included in the analysis: 195 (34%), 46 (8%) and 340 (59%) had no, moderate and severe circulatory failure, respectively. Resolution of circulatory failure at day 7 was more frequently observed in the normothermia group than in the TTM group (60% [95 %CI 54–66] versus 53% [95 %CI 46–60], Gray-test: p = 0.016). The severity of circulatory failure at randomization was associated with its less frequent resolution at day 7 accounting for the risk of death (76 % [62–86] versus 54% [49–59] for patients with moderate versus severe circulatory failure, Gray test, p < 0.001, respectively). At day 90, the proportion of patients with Cerebral Performance Category score of 1 or 2 was lower in patients presenting severe circulatory failure (p = 0.038). Conclusion: Circulatory failure is frequent after CA with non-shockable rhythm. Its severity at admission and TTM were associated with delayed resolution of circulatory failure. |
| first_indexed | 2024-04-11T20:24:40Z |
| format | Article |
| id | doaj.art-30a7fe93c084470f813150f9f67b0522 |
| institution | Directory Open Access Journal |
| issn | 2666-5204 |
| language | English |
| last_indexed | 2024-04-11T20:24:40Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj.art-30a7fe93c084470f813150f9f67b05222022-12-22T04:04:42ZengElsevierResuscitation Plus2666-52042022-09-0111100271Hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non-shockable rhythm: A post hoc analysis of a randomized controlled trialMatthieu Petit0Jean-Baptiste Lascarrou1Gwenhael Colin2Hamid Merdji3Alain Cariou4Guillaume Geri5Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; Paris-Saclay University, UVSQ, Inserm, CESP, 94807 Villejuif, France; Corresponding author at: Hôpital Ambroise Paré, 9, avenue Charles de Gaulle, 92100 Boulogne Billancourt, France.Médecine Intensive Réanimation, University Hospital Center, Nantes, France; Paris Cardiovascular Research Center, INSERM U970, Paris, France; AfterROSC Network, FranceMedical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, FranceUniversité de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive Réanimation, Strasbourg, France; UMR 1260, Regenerative Nano Medecine, INSERM, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, FranceParis Cardiovascular Research Center, INSERM U970, Paris, France; AfterROSC Network, France; Medical Intensive Care Unit, Cochin University Hospital Center, Paris, FranceMedical and Surgical Intensive Care Unit, Ambroise Paré Clinic, Neuilly-sur-Seine, FranceBackground: Patients admitted after cardiac arrest with non-shockable rhythm frequently experience hemodynamic instability. This study assessed the hemodynamic consequences of TTM in this sub population. Methods: This is a post hoc analysis of the HYPERION trial (NCT01994772), that randomized patients to either hypothermia or normothermia after non-shockable rhythm related cardiac arrest. Patients with no, moderate or severe circulatory failure were identified with cardiovascular Sequential Organ Failure Assessment at randomization. Primary outcome was the number of patients at day 7 with resolution of shock, accounting for the risk of death (competing risk analysis). Secondary endpoint included neurological outcome and death at day-90. Results: 584 patients were included in the analysis: 195 (34%), 46 (8%) and 340 (59%) had no, moderate and severe circulatory failure, respectively. Resolution of circulatory failure at day 7 was more frequently observed in the normothermia group than in the TTM group (60% [95 %CI 54–66] versus 53% [95 %CI 46–60], Gray-test: p = 0.016). The severity of circulatory failure at randomization was associated with its less frequent resolution at day 7 accounting for the risk of death (76 % [62–86] versus 54% [49–59] for patients with moderate versus severe circulatory failure, Gray test, p < 0.001, respectively). At day 90, the proportion of patients with Cerebral Performance Category score of 1 or 2 was lower in patients presenting severe circulatory failure (p = 0.038). Conclusion: Circulatory failure is frequent after CA with non-shockable rhythm. Its severity at admission and TTM were associated with delayed resolution of circulatory failure.http://www.sciencedirect.com/science/article/pii/S2666520422000716Cardiac arrestTargeted temperature managementPost resuscitation shockCirculatory failure |
| spellingShingle | Matthieu Petit Jean-Baptiste Lascarrou Gwenhael Colin Hamid Merdji Alain Cariou Guillaume Geri Hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non-shockable rhythm: A post hoc analysis of a randomized controlled trial Resuscitation Plus Cardiac arrest Targeted temperature management Post resuscitation shock Circulatory failure |
| title | Hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non-shockable rhythm: A post hoc analysis of a randomized controlled trial |
| title_full | Hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non-shockable rhythm: A post hoc analysis of a randomized controlled trial |
| title_fullStr | Hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non-shockable rhythm: A post hoc analysis of a randomized controlled trial |
| title_full_unstemmed | Hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non-shockable rhythm: A post hoc analysis of a randomized controlled trial |
| title_short | Hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non-shockable rhythm: A post hoc analysis of a randomized controlled trial |
| title_sort | hemodynamics and vasopressor support during targeted temperature management after cardiac arrest with non shockable rhythm a post hoc analysis of a randomized controlled trial |
| topic | Cardiac arrest Targeted temperature management Post resuscitation shock Circulatory failure |
| url | http://www.sciencedirect.com/science/article/pii/S2666520422000716 |
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