Vasopressor requirement during targeted temperature management for out-of-hospital cardiac arrest caused by acute myocardial infarction without cardiogenic shock

• Published in: Clinical and experimental emergency medicine Vol. 3; no. 1; pp. 20 - 26
• Main Authors: Song, Gyuho, You, Yeonho, Jeong, Wonjoon, Lee, Junwan, Cho, Yongchul, Lee, Seungwhan, Ryu, Seung, Lee, Jinwoong, Kim, Seungwhan, Yoo, Insool
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Emergency Medicine 01-03-2016; 대한응급의학회
• Subjects: hypothermia; myocardial infarction; Original; vasoconstrictor agents; 응급의학; Myocardial infarction; Vasoconstrictor agents; Hypothermia
• ISSN: 2383-4625; 2383-4625
• DOI: 10.15441/ceem.15.090

We investigated whether patients with out-of-hospital cardiac arrest (OHCA) due to an acute myocardial infarction without cardiogenic shock required higher doses of vasopressors with low targeted temperature management (TTM) after return of spontaneous circulation.
We included consecutive comatose patients resuscitated from OHCA between January 2011 and December 2013. Patients with return of spontaneous circulation, regional wall motion abnormality on echocardiography, and coronary artery stenosis of ≥70% on percutaneous coronary artery angiography were enrolled. These patients received 36°C TTM or 33°C TTM following approval of TTM by patients' next-of-kin (36°C and 33°C TTM groups, respectively). The cumulative vasopressor index was compared between groups.
During induction phase, dose of vasopressors did not differ between groups. In the maintenance phase, the norepinephrine dose was 0.37±0.57 and 0.26±0.91 µg·kg
·min
in the 33°C and 36°C TTM groups, respectively (P<0.01). During the rewarming phase, the norepinephrine and dopamine doses were 0.49±0.60 and 9.67±9.60 mcg·kg
·min
in the 33°C TTM group and 0.14±0.46 and 3.13±7.19 mcg·kg
·min
in the 36°C TTM group, respectively (P<0.01). The median cumulative vasopressor index was 8 (interquartile range, 3 to 8) and 4 (interquartile range, 0 to 8) in the 33°C and 36°C TTM groups, respectively (P=0.03).
In this study, patients with OHCA due to acute myocardial infarction without cardiogenic shock had an elevated vasopressor requirement with 33°C TTM compared to 36°C TTM during the maintenance and rewarming phases.