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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 (99th percentile)

Mentioned by

blogs
1 blog
twitter
189 tweeters
facebook
4 Facebook pages

Citations

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89 Dimensions

Readers on

mendeley
184 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

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.

Twitter Demographics

The data shown below were collected from the profiles of 189 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 184 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 181 98%

Demographic breakdown

Readers by professional status Count As %
Other 24 13%
Researcher 23 13%
Student > Postgraduate 21 11%
Student > Master 17 9%
Student > Bachelor 15 8%
Other 47 26%
Unknown 37 20%
Readers by discipline Count As %
Medicine and Dentistry 109 59%
Nursing and Health Professions 11 6%
Pharmacology, Toxicology and Pharmaceutical Science 8 4%
Agricultural and Biological Sciences 5 3%
Physics and Astronomy 1 <1%
Other 4 2%
Unknown 46 25%

Attention Score in Context

This research output has an Altmetric Attention Score of 126. 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
#189,318
of 17,522,550 outputs
Outputs from Critical Care
#90
of 5,345 outputs
Outputs of similar age
#5,024
of 267,287 outputs
Outputs of similar age from Critical Care
#1
of 58 outputs
Altmetric has tracked 17,522,550 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 5,345 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 16.8. This one has done particularly well, scoring higher than 98% 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 267,287 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 58 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 99% of its contemporaries.