title: Vasopressor requirement during targeted temperature management for out-of-hospital cardiac arrest caused by acute myocardial infarction without cardiogenic shock.
abstract: OBJECTIVE
  We investigated whether patients with out-of-hospital cardiac arrest (OHCA) due to an acute myocardial infarction without cardiogenic shock required higher doses of vasopressors with low targeted temperature management (TTM) after return of spontaneous circulation.
  
  
  METHODS
  We included consecutive comatose patients resuscitated from OHCA between January 2011 and December 2013. Patients with return of spontaneous circulation, regional wall motion abnormality on echocardiography, and coronary artery stenosis of ≥70% on percutaneous coronary artery angiography were enrolled. These patients received 36°C TTM or 33°C TTM following approval of TTM by patients' next-of-kin (36°C and 33°C TTM groups, respectively). The cumulative vasopressor index was compared between groups.
  
  
  RESULTS
  During induction phase, dose of vasopressors did not differ between groups. In the maintenance phase, the norepinephrine dose was 0.37±0.57 and 0.26±0.91 µg·kg-1·min-1in the 33°C and 36°C TTM groups, respectively (P<0.01). During the rewarming phase, the norepinephrine and dopamine doses were 0.49±0.60 and 9.67±9.60 mcg·kg-1·min-1in the 33°C TTM group and 0.14±0.46 and 3.13±7.19 mcg·kg-1·min-1in the 36°C TTM group, respectively (P<0.01). The median cumulative vasopressor index was 8 (interquartile range, 3 to 8) and 4 (interquartile range, 0 to 8) in the 33°C and 36°C TTM groups, respectively (P=0.03).
  
  
  CONCLUSIONS
  In this study, patients with OHCA due to acute myocardial infarction without cardiogenic shock had an elevated vasopressor requirement with 33°C TTM compared to 36°C TTM during the maintenance and rewarming phases.
authors.affiliation: Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Gyuho
authors.initials: G
authors.lastname: Song
authors.affiliation: Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Yeonho
authors.initials: Y
authors.lastname: You
authors.affiliation: Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Wonjoon
authors.initials: W
authors.lastname: Jeong
authors.affiliation: Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Junwan
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Yongchul
authors.initials: Y
authors.lastname: Cho
authors.affiliation: Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Seungwhan
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Seung
authors.initials: S
authors.lastname: Ryu
authors.affiliation: Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Jinwoong
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Seungwhan
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Insool
authors.initials: I
authors.lastname: Yoo
keywords: Hypothermia; Myocardial infarction; Vasoconstrictor agents