Comparison between norepinephrine plus epinephrine and norepinephrine plus vasopressin after return of spontaneous circulation in patients with out-of-hospital cardiac arrest

There is insufficient evidence regarding the use of second-line vasopressors following norepinephrine administration in the post-resuscitation management of patients with out-of-hospital cardiac arrest (OHCA). Therefore, this study aimed to investigate the survival outcomes between norepinephrine plus epinephrine and norepinephrine plus vasopressin as vasopressor combinations after return of spontaneous circulation (ROSC) in patients with OHCA. This retrospective observational study included data from a prospective multicenter registry. Adult patients with OHCA who achieved sustained ROSC and received vasopressor combinations of norepinephrine plus epinephrine or norepinephrine plus vasopressin were included in the study. The variable of interest was the vasopressor combination either norepinephrine plus epinephrine or norepinephrine plus vasopressin within 24 h from sustained ROSC. The primary outcome was survival to discharge. Multivariable logistic regression analysis was conducted. Between October 2015 and June 2024, 901 patients were analyzed. Survival to discharge and good neurological outcome were significantly higher in the group with norepinephrine plus epinephrine than in the group with norepinephrine plus vasopressin (17.0% vs. 9.1%, p = 0.001, and 8.1% vs. 3.2%, p = 0.002, respectively). Norepinephrine plus vasopressin was independently associated with worse survival to discharge and neurological outcome compared to norepinephrine plus epinephrine, after adjusting for potential confounders (adjusted odds ratio [aOR] 0.454, 95% confidence interval [CI] 0.277-0.746, p = 0.002 and aOR 0.346, 95% CI 0.150-0.794, p = 0.012, respectively). These findings were maintained in multiple regression models and sensitivity analyses. Norepinephrine plus epinephrine administration within 24 h from sustained ROSC showed better survival to discharge than norepinephrine plus vasopressin in patients with OHCA.

Authors

Institutions

Publication Details

Journal
Scientific Reports
Published
2025-04-18
DOI
https://doi.org/10.1038/s41598-025-96857-z
Citations
1
Primary Topic
Cardiac Arrest and Resuscitation
Type
article
Field-Weighted Citation Impact
2.25
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Comparison between norepinephrine plus epinephrine and norepinephrine plus vasopressin after return of spontaneous circulation in patients with out-of-hospital cardiac arrest

Han‐Jin Cho, Bo-Yeong Jin, Jong-Hak Park, Sukyo Lee et al.
1 citations
Scientific Reports
Cardiac Arrest and Resuscitation
2.25
article

Comparison between norepinephrine plus epinephrine and norepinephrine plus vasopressin after return of spontaneous circulation in patients with out-of-hospital cardiac arrest

Han‐Jin Cho, Bo-Yeong Jin, Jong-Hak Park, Sukyo Lee, Sejoong Ahn, Sungwoo Moon
article en
1 citations

Abstract

There is insufficient evidence regarding the use of second-line vasopressors following norepinephrine administration in the post-resuscitation management of patients with out-of-hospital cardiac arrest (OHCA). Therefore, this study aimed to investigate the survival outcomes between norepinephrine plus epinephrine and norepinephrine plus vasopressin as vasopressor combinations after return of spontaneous circulation (ROSC) in patients with OHCA. This retrospective observational study included data from a prospective multicenter registry. Adult patients with OHCA who achieved sustained ROSC and received vasopressor combinations of norepinephrine plus epinephrine or norepinephrine plus vasopressin were included in the study. The variable of interest was the vasopressor combination either norepinephrine plus epinephrine or norepinephrine plus vasopressin within 24 h from sustained ROSC. The primary outcome was survival to discharge. Multivariable logistic regression analysis was conducted. Between October 2015 and June 2024, 901 patients were analyzed. Survival to discharge and good neurological outcome were significantly higher in the group with norepinephrine plus epinephrine than in the group with norepinephrine plus vasopressin (17.0% vs. 9.1%, p = 0.001, and 8.1% vs. 3.2%, p = 0.002, respectively). Norepinephrine plus vasopressin was independently associated with worse survival to discharge and neurological outcome compared to norepinephrine plus epinephrine, after adjusting for potential confounders (adjusted odds ratio [aOR] 0.454, 95% confidence interval [CI] 0.277-0.746, p = 0.002 and aOR 0.346, 95% CI 0.150-0.794, p = 0.012, respectively). These findings were maintained in multiple regression models and sensitivity analyses. Norepinephrine plus epinephrine administration within 24 h from sustained ROSC showed better survival to discharge than norepinephrine plus vasopressin in patients with OHCA.

Scientific ReportsVol. 15(1)
Seoul National University (KR), Hallym University (KR), Yonsei University (KR), Korea University (KR), Dongguk University (KR), Eulji University (KR), Severance Hospital (KR), Korea University Medical Center (KR), Bundang Jesaeng Hospital (KR), Kyungpook National University Hospital (KR), Asan Medical Center (KR), Samsung Medical Center (KR), Seoul National University Hospital (KR), Seoul National University Bundang Hospital (KR), Ansan University (KR), Sacred Heart Hospital (NG), Seoul Medical Center (KR), Gachon University Gil Medical Center (KR), Gyeongsang National University Hospital (KR), Konkuk University Medical Center (KR), Hallym University Kangnam Sacred Heart Hospital (KR), SNUH SMG-SNU Boramae Medical Center (KR), Chosun University Hospital (KR), Wonju Severance Christian Hospital (KR), Ajou University Hospital (KR), Kangbuk Samsung Hospital (KR), Konyang University Hospital (KR), Dongguk University Ilsan Hospital (KR), Kangwon National University Hospital (KR), Pusan National University Hospital (KR), Cheju Halla General Hospital (KR), Hanil General Hospital (KR), Hanyang University Guri Hospital (KR), Keimyung University Dongsan Medical Center (KR), Sejong General Hospital (KR), Jeonbuk National University Hospital (KR), CHA University Bundang Medical Center (KR), Kyung Hee University Dental Hospital (KR), Ulsan University Hospital (KR), Hanyang University Seoul Hospital (KR), Chungnam National University Hospital (KR), Myongji Hospital (KR), Gangnam Severance Hospital (KR), Sacred Heart Hospital (US), Kangdong Sacred Heart Hospital (KR), Catholic Kwandong University International St. Mary's Hospital (KR), Hallym University Dongtan Sacred Heart Hospital (KR), Chungbuk National University Hospital (KR), Hallym University Chuncheon Sacred Heart Hospital (KR), Jeju National University Hospital (KR), Dankook University Hospital (KR), Dongguk University WISE, Keimyung University (KR), Wonkwang University (KR), Catholic Kwandong University (KR)
Good health and well-being
Openalex Percentile: Top 15%
Cardiac Arrest and Resuscitation
2.25
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.