• Crit Care · Sep 2019

    Epinephrine, inodilator, or no inotrope in venoarterial extracorporeal membrane oxygenation implantation: a single-center experience.

    • Viviane Zotzmann, Jonathan Rilinger, Corinna N Lang, Klaus Kaier, Christoph Benk, Daniel Duerschmied, Paul M Biever, Christoph Bode, Tobias Wengenmayer, and Dawid L Staudacher.
    • Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany. viviane.zotzmann@uniklinik-freiburg.de.
    • Crit Care. 2019 Sep 18; 23 (1): 320.

    BackgroundVenoarterial extracorporeal membrane oxygenation (VA-ECMO) can be a rescue therapy for patients in cardiogenic shock or in refractory cardiac arrest. After cannulation, vasoplegia and cardiac depression are frequent. In literature, there are conflicting data on inotropic therapy in these patients.MethodsAnalysis of a retrospective registry of all patients treated with VA-ECMO in a university hospital center between October 2010 and December 2018 for cardiogenic shock or extracorporeal cardiopulmonary resuscitation (eCPR) with a focus on individual early inotropic therapy.ResultsA total of 231 patients (age 58.6 ± 14.3, 29.9% female, 58% eCPR, in-house survival 43.7%) were analyzed. Of these, 41.6% received no inotrope therapy within the first 24 h (survival 47.9%), 29.0% received an inodilator (survival 52.2%), and 29.0% received epinephrine (survival 25.0%). Survival of patients with epinephrine was significantly worse compared to other patient groups when evaluating 30-day survival (p = 0.034/p = 0.005) and cumulative incidence of in-hospital death (p = 0.001). In a multivariate logistic regression analysis, treatment with epinephrine was associated with mortality in the whole cohort (OR 0.38, p = 0.011) as well as after propensity score matching (OR 0.24, p = 0.037). We found no significant differences between patients with inodilator treatment and those without.ConclusionEarly epinephrine therapy within the first 24 h after cannulation for VA-ECMO was associated with poor survival compared to patients with or without any inodilator therapy. Until randomized data are available, epinephrine should be avoided in patients on VA-ECMO.

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