• Christine K Lawson, Brett A Faine, Megan A Rech, Christopher A Childs, Caitlin S Brown, Giles W Slocum, Nicole M Acquisto, Lance Ray, and EMPHARM-NET Study Group.
• Department of Pharmacy, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA. Electronic address: clawson@lifespan.org.
• Am J Emerg Med. 2024 Mar 1; 77: 158163158-163.

PurposeThe preferred vasopressor in post-cardiac arrest shock has not been established with robust clinical outcomes data. Our goal was to perform a systematic review and meta-analysis comparing rates of in-hospital mortality, refractory shock, and hemodynamic parameters in post-cardiac arrest patients who received either norepinephrine or epinephrine as primary vasopressor support.MethodsWe conducted a search of PubMed, Cochrane Library, and CINAHL from 2000 to 2022. Included studies were prospective, retrospective, or published abstracts comparing norepinephrine and epinephrine in adults with post-cardiac arrest shock or with cardiogenic shock and extractable post-cardiac arrest data. The primary outcome of interest was in-hospital mortality. Other outcomes included incidence of arrhythmias or refractory shock.ResultsThe database search returned 2646 studies. Two studies involving 853 participants were included in the systematic review. The proposed meta-analysis was deferred due to low yield. Crude incidence of in-hospital mortality was numerically higher in the epinephrine group compared with norepinephrine in both studies, but only statistically significant in one. Risk of bias was moderate to severe for in-hospital mortality. Additional outcomes were reported differently between studies, minimizing direct comparison.ConclusionThe vasopressor with the best mortality and hemodynamic outcomes in post-cardiac arrest shock remains unclear. Randomized studies are crucial to remedy this.Copyright © 2023 Elsevier Inc. All rights reserved.

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