Comparison of Dopamine and Norepinephrine Use for the Treatment of Hypotension in Out-Of-Hospital Cardiac Arrest Patients with Return of Spontaneous Circulation.

Chao-Jui Li,Yat-Yin Law,Kuan-Han Wu,Yi-Chuan Chen,Po-Chun Chuang,Chien-Chih Chen

doi:10.1155/2020/7951025

Abstract

In patients experiencing out-of-hospital cardiac arrest (OHCA), hypotension is common after return of spontaneous circulation (ROSC). Both dopamine and norepinephrine are recommended as inotropic therapeutic agents. This study aimed to determine the impact of the use of these two medications on hypotension. This is a multicenter retrospective cohort study. OHCA patients with ROSC were divided into three groups according to the post resuscitation inotropic agent used for treatment in the emergency department, namely, dopamine, norepinephrine, and dopamine and norepinephrine combined therapy. Thirty-day survival and favorable neurologic performance were analyzed among the three study groups. The 30-day survival and favorable neurologic performance rates in the three study groups were 12.5%, 13.0%, and 6.8% as well as 4.9%, 4.3%, and 1.2%, respectively. On controlling the potential confounding factors by logistic regression, there was no difference between dopamine and norepinephrine treatment in survival and neurologic performance (adjusted odds ratio (aOR): 1.0, 95% confidence interval (CI) 0.48-2.06; aOR: 0.8, 95% CI: 0.28-2.53). The dopamine and norepinephrine combined treatment group had worse outcome (aOR: 0.6, 95% CI: 0.35-1.18; aOR: 0.2, 95% CI: 0.05-0.89). In conclusion, there was no significant difference in post-ROSC hypotension treatment between dopamine and norepinephrine in 30-day survival and favorable neurologic performance rates.

Highlights

In patients developing out-of-hospital cardiac arrest (OHCA), hypotension often occurs within minutes to hours of return of spontaneous circulation (ROSC) [1, 2]
Post-ROSC hypotension is a predictor of in-hospital death and is associated with diminished functional status among survivors [3, 4]. erefore, post-ROSC hypotension should be treated aggressively
Patients who developed ROSC were divided into three treatment groups (Figure 1). ere were 670 with dopamine, 92 with norepinephrine, and 249 with dopamine and norepinephrine combined therapy

Summary

Introduction

In patients developing out-of-hospital cardiac arrest (OHCA), hypotension often occurs within minutes to hours of return of spontaneous circulation (ROSC) [1, 2]. Dopamine and norepinephrine are both commonly used inotropic therapeutic agents for hypotension [5]. Norepinephrine is a naturally occurring potent vasoconstrictor and an inotropic agent. Backer et al reported that the use of dopamine was associated with a greater number of adverse events for shock patients [5]. Is is because dopamine is associated with greater mortality and has a higher incidence of arrhythmic events than that of norepinephrine [6]. We aimed to determine the impact of the use of dopamine and norepinephrine on hypotension in ROSC patients

Objectives

Results

Conclusion