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The following is a summary of “Norepinephrine versus epinephrine for hemodynamic support in post-cardiac arrest shock: A systematic review,” published in the March 2024 issue of Emergency Medicine by Lawson, et al.

Identifying the optimal vasopressor for post-cardiac arrest shock lacks strong evidence from clinical outcomes. For a study, researchers sought to conduct a systematic review and meta-analysis comparing in-hospital mortality, refractory shock rates, and hemodynamic parameters in patients with post-cardiac arrest treated with either norepinephrine or epinephrine as primary vasopressor support.

A comprehensive search was performed in PubMed, Cochrane Library, and CINAHL from 2000 to 2022. Eligible studies included prospective or retrospective analyses and published abstracts comparing norepinephrine and epinephrine in adults with post-cardiac arrest shock or cardiogenic shock with retrievable post-cardiac arrest data. The primary outcome assessed was in-hospital mortality, while secondary outcomes encompassed arrhythmia incidence and refractory shock.

The initial database query yielded 2,646 studies, from which two studies involving 853 participants met the inclusion criteria for systematic review. However, conducting a meta-analysis was deferred due to limited data availability. While both studies suggested a numerically higher crude incidence of in-hospital mortality in the epinephrine group compared to norepinephrine, statistical significance was observed in only one study. A moderate to severe risk of bias was identified regarding in-hospital mortality. Furthermore, variations in reporting additional outcomes across studies could have helped direct comparison.

The optimal vasopressor choice for post-cardiac arrest shock remained uncertain due to limited evidence. Randomized controlled trials were imperative to address the knowledge gap and effectively guide clinical practice.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723007106