SESSION TITLE: Severe Sepsis & Septic Shock SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: The 2012 Surviving Sepsis guidelines (SSG) recommended norepinephrine (NE) as the first-line vasopressor in the management of septic shock. Epinephrine (EP) was recommended as the second-line vasopressors; however in clinical practice, vasopressin (VP) is often used instead. Our goal was to compare vasopressin to epinephrine as the second-line vasopressor in septic shock. METHODS: We performed a retrospective cohort study of patients identified to have septic shock based on ICD-9/10 codes from 04/01/2014 to 12/31/2016. Inclusion criteria were age≥18, ICU admission and treatment with vasopressor combination of either NE+EP (Group 1), NE+VP (Group 2), or NE+VP+EP (Group 3). Statistical analysis was performed using SAS 9.4. Analysis of variance was performed for continuous variables and Chi-squared and Fisher’s exact test was performed for categorical variables. Logistic regression was performed of adjusted analyses. RESULTS: Of the 226 patients analyzed, a total of 7, 52, and 10 patients were identified in Groups 1, 2, and 3 respectively. Group 1 had higher 28-day mortality as compared to groups 2 and 3 (100% vs. 73% vs. 90%, p=0.03) and increased rate of new arrhythmias (71.43% vs. 39.22% vs. 50.00%, p=0.0230). There was no difference in ICU length of stay and ventilator days. Mean APACHE II scores were significantly higher in Group 1 compared to groups 2 and 3 (39.57 vs. 29.94 vs. 26.90). After adjusting for APACHE II scores, there was no significant difference in mortality between the groups (p=0.1412). Group 1 had a higher incidence of systolic heart failure compared to groups 1 and 3 (71.43% vs. 25.00% vs. 30.00%, p=0.0059), diabetes (71.43% vs. 25.00% vs. 40.00%, p=0.0048) and DIC (57.14% vs. 25.00% vs. 40.00%, p=0.0173). Patients on NE alone were less likely to be dead at 28 days (OR 0.512, 95% CI 0.294-0.89, p=0.0183). CONCLUSIONS: Despite the 2012 SSG recommendations, VP was more commonly used than EP as the second vasopressor. The combination of NE+ EP was associated with increased arrhythmias and mortality, however not when adjusted for APACHE II scores, suggesting that EP was used in patients with greater severity of septic shock. Further studies are needed to further elucidate the ideal second vasopressor. CLINICAL IMPLICATIONS: The combination of NE+EP is used in patients with septic shock with high severity of illness and may be associated with increased arrhythmias and mortality. DISCLOSURE: The following authors have nothing to disclose: Boram Kim, Manideep Duttuluri, Rupa Iyengar, Di Pan, Nader Ishak Gabra, Lee Sung, Hassan Khouli, Joseph Mathew No Product/Research Disclosure Information