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Current real-life use of vasopressors and inotropes in cardiogenic shock - adrenaline use is associated with excess organ injury and mortality

Overview of attention for article published in Critical Care, July 2016
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (98th percentile)
  • High Attention Score compared to outputs of the same age and source (94th percentile)

Mentioned by

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1 blog
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176 X users
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4 Facebook pages

Citations

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154 Dimensions

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240 Mendeley
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Title
Current real-life use of vasopressors and inotropes in cardiogenic shock - adrenaline use is associated with excess organ injury and mortality
Published in
Critical Care, July 2016
DOI 10.1186/s13054-016-1387-1
Pubmed ID
Authors

Tuukka Tarvasmäki, Johan Lassus, Marjut Varpula, Alessandro Sionis, Reijo Sund, Lars Køber, Jindrich Spinar, John Parissis, Marek Banaszewski, Jose Silva Cardoso, Valentina Carubelli, Salvatore Di Somma, Alexandre Mebazaa, Veli-Pekka Harjola, for the CardShock study investigators

Abstract

Vasopressors and inotropes remain a cornerstone in stabilization of the severely impaired hemodynamics and cardiac output in cardiogenic shock (CS). The aim of this study was to analyze current real-life use of these medications, and their impact on outcome and on changes in cardiac and renal biomarkers over time in CS. The multinational CardShock study prospectively enrolled 219 patients with CS. The use of vasopressors and inotropes was analyzed in relation to the primary outcome, i.e., 90-day mortality, with propensity score methods in 216 patients with follow-up data available. Changes in cardiac and renal biomarkers over time until 96 hours from baseline were analyzed with linear mixed modeling. Patients were 67 (SD 12) years old, 26 % were women, and 28 % had been resuscitated from cardiac arrest prior to inclusion. On average, systolic blood pressure was 78 (14) and mean arterial pressure 57 (11) mmHg at detection of shock. 90-day mortality was 41 %. Vasopressors and/or inotropes were administered to 94 % of patients and initiated principally within the first 24 hours. Noradrenaline and adrenaline were given to 75 % and 21 % of patients, and 30 % received several vasopressors. In multivariable logistic regression, only adrenaline (21 %) was independently associated with increased 90-day mortality (OR 5.2, 95 % CI 1.88, 14.7, p = 0.002). The result was independent of prior cardiac arrest (39 % of patients treated with adrenaline), and the association remained in propensity-score-adjusted analysis among vasopressor-treated patients (OR 3.0, 95 % CI 1.3, 7.2, p = 0.013); this was further confirmed by propensity-score-matched analysis. Adrenaline was also associated, independent of prior cardiac arrest, with marked worsening of cardiac and renal biomarkers during the first days. Dobutamine and levosimendan were the most commonly used inotropes (49 % and 24 %). There were no differences in mortality, whether noradrenaline was combined with dobutamine or levosimendan. Among vasopressors and inotropes, adrenaline was independently associated with 90-day mortality in CS. Moreover, adrenaline use was associated with marked worsening in cardiac and renal biomarkers. The combined use of noradrenaline with either dobutamine or levosimendan appeared prognostically similar.

X Demographics

X Demographics

The data shown below were collected from the profiles of 176 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 240 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 1 <1%
Portugal 1 <1%
South Africa 1 <1%
Unknown 237 99%

Demographic breakdown

Readers by professional status Count As %
Researcher 28 12%
Other 27 11%
Student > Bachelor 26 11%
Student > Postgraduate 23 10%
Student > Master 21 9%
Other 54 23%
Unknown 61 25%
Readers by discipline Count As %
Medicine and Dentistry 130 54%
Nursing and Health Professions 17 7%
Pharmacology, Toxicology and Pharmaceutical Science 9 4%
Agricultural and Biological Sciences 5 2%
Neuroscience 2 <1%
Other 5 2%
Unknown 72 30%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 119. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 24 January 2019.
All research outputs
#353,344
of 25,546,214 outputs
Outputs from Critical Care
#187
of 6,584 outputs
Outputs of similar age
#7,012
of 370,205 outputs
Outputs of similar age from Critical Care
#7
of 114 outputs
Altmetric has tracked 25,546,214 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 98th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,584 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.8. This one has done particularly well, scoring higher than 97% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 370,205 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 98% of its contemporaries.
We're also able to compare this research output to 114 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 94% of its contemporaries.