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Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients

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A Correction to this article was published on 13 September 2018

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Abstract

Objective

Catecholamines have been the mainstay of pharmacological treatment of cardiogenic shock (CS). Recently, use of epinephrine has been associated with detrimental outcomes. In the present study we aimed to evaluate the association between epinephrine use and short-term mortality in all-cause CS patients.

Design

We performed a meta-analysis of individual data with prespecified inclusion criteria: (1) patients in non-surgical CS treated with inotropes and/or vasopressors and (2) at least 15% of patients treated with epinephrine administrated alone or in association with other inotropes/vasopressors. The primary outcome was short-term mortality.

Measurements and results

Fourteen published cohorts and two unpublished data sets were included. We studied 2583 patients. Across all cohorts of patients, the incidence of epinephrine use was 37% (17–76%) and short-term mortality rate was 49% (21–69%). A positive correlation was found between percentages of epinephrine use and short-term mortality in the CS cohort. The risk of death was higher in epinephrine-treated CS patients (OR [CI] = 3.3 [2.8–3.9]) compared to patients treated with other drug regimens. Adjusted mortality risk remained striking in epinephrine-treated patients (n = 1227) (adjusted OR = 4.7 [3.4–6.4]). After propensity score matching, two sets of 338 matched patients were identified and epinephrine use remained associated with a strong detrimental impact on short-term mortality (OR = 4.2 [3.0–6.0]).

Conclusions

In this very large cohort, epinephrine use for hemodynamic management of CS patients is associated with a threefold increase of risk of death.

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Change history

  • 13 September 2018

    Because of a technical error, the code corresponding to the outcome for the Basir et al. cohort was mis-implemented in the original version of our article. Characteristics of the cohort are in fact the followings.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot and INSERM UMR-S 942, Paris, France

    Valentine Léopold, Etienne Gayat, Alexandre Mebazaa & Tahar Chouihed

  2. Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, Paris, France

    Romain Pirracchio

  3. Cardiology Department, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic

    Jindrich Spinar & Jiri Parenica

  4. Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland

    Tuukka Tarvasmäki, Johan Lassus & Veli-Pekka Harjola

  5. Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Tuukka Tarvasmäki

  6. Intensive Care Unit, University Hospital Félix Guyon, Saint Denis, France

    Sébastien Champion

  7. CIC-Plurithématique, INSERM, University Hospital of Nancy, Nancy, France

    Faiez Zannad & Tahar Chouihed

  8. Intensive Cardiac Care Unit, Florence University Hospital, Careggi, Florence, Italy

    Serafina Valente

  9. Cardiovascular Department, Hôpital de la Tour, Meyrin-Geneva, Switzerland

    Philip Urban

  10. Department of Intensive Care, Austin Hospital, Melbourne, Australia

    Horng-Ruey Chua & Rinaldo Bellomo

  11. Australian and New Zealand Intensive Care Research Centre (ANZIC RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

    Horng-Ruey Chua & Rinaldo Bellomo

  12. School of Medicine, The University of Melbourne, Melbourne, Australia

    Horng-Ruey Chua & Rinaldo Bellomo

  13. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia

    Horng-Ruey Chua & Rinaldo Bellomo

  14. Division of Nephrology, National University Health System, University Medicine Cluster, Singapore, Singapore

    Horng-Ruey Chua

  15. Cardiology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France

    Batric Popovic

  16. AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Dagmar M. Ouweneel & José P. S. Henriques

  17. Department of Medicine/Cardiology, Heart Center Dresden University of Technology, Dresden, Germany

    Gregor Simonis

  18. Praxisklinik Herz und Gefaesse, Dresden, Germany

    Gregor Simonis

  19. Intensive Care Unit, Faculty of Medicine, University Hospital of Nancy, France, and U1116, Vandoeuvre-lès-Nancy, France

    Bruno Lévy & Antoine Kimmoun

  20. Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France

    Philippe Gaudard

  21. Division of Cardiology, Henry Ford Hospital, 2799W. Grand Blvd ‐ K14, Detroit, MI, 48202, USA

    Mir Babar Basir

  22. Medical Intensive Care Unit, University Medical Centre Maribor, Ljubljanska, Maribor, Slovenia

    Andrej Markota

  23. Department of Internal Medicine III, University of Cologne, Cologne, Germany

    Christoph Adler & Hannes Reuter

  24. Investigation Network Initiative – Cardiovascular and Renal Clinical Trialists, INI-CRCT, Nancy, France

    Alexandre Mebazaa

  25. Emergency Department, University Hospital of Nancy, Nancy, France

    Tahar Chouihed

  26. INSERM U1116, University of Lorraine, Nancy, France

    Tahar Chouihed

Authors
  1. Valentine Léopold
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  2. Etienne Gayat
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  3. Romain Pirracchio
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  27. Tahar Chouihed
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Corresponding author

Correspondence to Alexandre Mebazaa.

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Conflict of interest

AM received lecture fees from Novartis, Orion and Abbott, research grants from Roche and consultant fees from Servier and Sanofi. Other coauthors have no conflicts to declare.

Authors' comment

One of the two unpublished data set-the one of Basir-was published after data extraction, and is refered as [35].

Additional information

Valentine Léopold and Etienne Gayat are co-first authors.

Alexandre Mebazaa and Tahar Chouihed are co-last authors.

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Léopold, V., Gayat, E., Pirracchio, R. et al. Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients. Intensive Care Med 44, 847–856 (2018). https://doi.org/10.1007/s00134-018-5222-9

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  • DOI: https://doi.org/10.1007/s00134-018-5222-9

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