Early High-Dose Erythropoietin Therapy After Out-of-Hospital Cardiac Arrest

Cariou, Alain; Deye, Nicolas; Vivien, Benoît; Richard, Olivier; Pichon, Nicolas; Bourg, Angèle; Huet, Loïc; Buléon, Clément; Frey, J.; Asfar, Pierre; Legriel, Stéphane; Narcisse, Sophie; Mathonnet, Armelle; Cravoisy, Aurélie; Dequin, Pierre‐François; Wiel, É.; Razazi, Keyvan; Daubin, Cédric; Kimmoun, Antoine; Lamhaut, Lionel; Marx, J.-S.; Garanderie, Didier Payen de La; Ecollan, Patrick; Combes, Alain; Spaulding, Christian; Barat, Florence; Boutieb, Myriam Ben; Coste, Joël; Chiche, Jean‐Daniel; Pène, Frédéric; Mira, Jean‐Paul; Tréluyer, Jean‐Marc; Hermine, Olivier; Carli, Pierre

doi:10.1016/j.jacc.2016.04.040

Cited by 48 publications

(31 citation statements)

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“…A total of 47 studies were identified after exclusion of duplicate or irrelevant references (Figure 1 ). After detailed evaluation, 3 clinical trials (2 case-controlled studies and 1 randomized controlled study) with a total of 606 patients (276 patients received Epo in conjunction to standard of care compared to 330 patients with standard of care alone) were included in our analysis[ 9 - 11 ]. The characteristics of these trials and mean follow-up periods are described in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…However, this did not translate into a significant clinical benefit in patients with either acute myocardial infarction or stroke[ 6 - 8 ]. In the setting of OHCA, there is whole body ischemia and clinical studies have shown conflicting results with 2 studies demonstrating mortality benefit with early Epo administration[ 9 , 10 ] and a recent randomized controlled trial with no significant benefit[ 11 ]. In view of these studies, we aim to perform a meta-analysis to assess for any significant mortality benefit of early Epo administration in patients with OHCA.…”

Section: Introductionmentioning

confidence: 99%

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Erythropoietin therapy after out-of-hospital cardiac arrest: A systematic review and meta-analysis

Chaudhary

Garg

Krishnamoorthy

et al. 2017

WJC

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AIMTo assess safety and efficacy of early erythropoietin (Epo) administration in patients with out-of-hospital cardiac arrest (OHCA).METHODSA systematic literature search was performed using PubMed, MEDLINE, EMBASE, EBSCO, CINAHL, Web of Science and Cochrane databases, of all studies published from the inception through October 10, 2016. Inclusion criteria included: (1) Adult humans with OHCA and successful sustained return of spontaneous circulation; and (2) studies including mortality/brain death, acute thrombotic events as their end points. Primary efficacy outcome was “brain death or Cerebral Performance Category (CPC) score of 5”. Secondary outcomes were “CPC score 1, and 2-4”, “overall thrombotic events” and “acute coronary stent thrombosis”.RESULTSWe analyzed a total of 606 participants (n = 276 received Epo and n = 330 with standard of care alone) who experienced OHCA enrolled in 3 clinical trials. No significant difference was observed between the Epo and no Epo group in brain death or CPC score 5 (OR = 0.77; 95%CI: 0.42-1.39), CPC score 1 (OR = 1.16, 95%CI: 0.82-1.64), and CPC score 2-4 (OR = 0.77, 95%CI: 0.44-1.36). Epo group was associated with increased thrombotic complications (OR = 2.41, 95%CI: 1.26-4.62) and acute coronary stent thrombosis (OR = 8.16, 95%CI: 1.39-47.99). No publication bias was observed.CONCLUSIONOur study demonstrates no improvement in neurological outcomes and increased incidence of thrombotic events and acute coronary stent thrombosis in OHCA patients who were treated with Epo in addition to standard therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Erythropoietin therapy after out-of-hospital cardiac arrest: A systematic review and meta-analysis

Chaudhary

Garg

Krishnamoorthy

et al. 2017

WJC

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“…New onset hypertension or worsening of existing hypertension is relatively common and is associated with increased plasma volume. 7,170,171,[433][434][435][436][437][438] It should also be mentioned that female hormones (e.g., oral contraception, hormone replacement therapy) can increase blood pressure and cause arterial thrombosis, but because of their higher incidence of venous thrombotic events, they will be discussed in the chapter 3.6.1.…”

Section: Erythropoietin and Its Analoguesmentioning

confidence: 99%

Comprehensive review of cardiovascular toxicity of drugs and related agents

Mladěnka

Applová

Patočka

et al. 2018

Medicinal Research Reviews

215

120

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Cardiovascular diseases are a leading cause of morbidity and mortality in most developed countries of the world. Pharmaceuticals, illicit drugs, and toxins can significantly contribute to the overall cardiovascular burden and thus deserve attention. The present article is a systematic overview of drugs that may induce distinct cardiovascular toxicity. The compounds are classified into agents that have significant effects on the heart, blood vessels, or both. The mechanism(s) of toxic action are discussed and treatment modalities are briefly mentioned in relevant cases. Due to the large number of clinically relevant compounds discussed, this article could be of interest to a broad audience including pharmacologists and toxicologists, pharmacists, physicians, and medicinal chemists. Particular emphasis is given to clinically relevant topics including the cardiovascular toxicity of illicit sympathomimetic drugs (e.g., cocaine, amphetamines, cathinones), drugs that prolong the QT interval, antidysrhythmic drugs, digoxin and other cardioactive steroids, beta‐blockers, calcium channel blockers, female hormones, nonsteroidal anti‐inflammatory, and anticancer compounds encompassing anthracyclines and novel targeted therapy interfering with the HER2 or the vascular endothelial growth factor pathway.

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“…The impact of early high-dose erythropoietin was also investigated in patients after OHCA in a single blind randomized trial but neither mortality, neither Cerebral Performance Category (CPC) scale improved after this treatment, only rate of thrombotic complications increased [38].…”

Section: Pharmacologic Strategiesmentioning

confidence: 99%

Strategies of Neuroprotection after Successful Resuscitation

Kovács¹,

Zima²

2017

Resuscitation Aspects

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Post-cardiac arrest syndrome (PCAS) incorporates post-cardiac arrest brain injury, postcardiac arrest myocardial dysfunction, systemic ischemia/reperfusion syndrome and the precipitating pathology. Brain injury remains the leading cause of death in the postcardiac arrest period. One of our main goals during post-resuscitation care is to guide a proper neuroprotective strategy. We are going to summarize the tools of neuroprotection in post-cardiac arrest therapy. The role of normoxia/normocapnia, normoglycemia, seizure control, sedation and pharmacologic strategies will be discussed in brief. The handling of temperature management and the management of hemodynamic variables to secure satisfactory cerebral perfusion will be worked out in details. Targeted temperature management is the main tool of neuroprotection in post-cardiac arrest therapy. We are going to conclude the principles of temperature control after successful resuscitation pointing out its beneficial effects. This method has also several complications that are going to be discussed highlighting its hemodynamic impacts. There is no evidence about target hemodynamic parameters during post-cardiac arrest syndrome to maintain cerebral perfusion neither about the most effective hemodynamic monitoring system. We are presenting preliminary data of our study where we investigate the effect of PiCCO™ (Pulse index Continous Cardiac Output) monitoring on the outcome in this patient group.Keywords: post-cardiac arrest syndrome, post-cardiac arrest brain injury, post-resuscitation therapy, targeted temperature management, hemodynamic parameters IntroductionSudden cardiac arrest is one of the leading causes of death in Europe [1]. The outcome is still very poor: the hospital discharge varies between 7 and 10% after out-of-hospital cardiac arrest (OHCA) and it is approximately 25% after in-hospital cardiac arrest (IHCA) [1]. The chain of © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.survival describes links that lead to a successful resuscitation [2]. The fourth element covers proper post-resuscitation care to restore quality of life. It is well known that the management of post-resuscitation cardiac arrest syndrome affects outcome and it is an important part of the resuscitation process. Pointing out the growing importance of post-resuscitation therapy, the European Resuscitation Council (ERC) introduced a separate chapter about post-resuscitation care in the 2015 guidelines [3]. One of the key elements to improve survival rate after sudden cardiac arrest may be the enhancement of post-resuscitation therapy.The post-cardiac arrest brain injury remains the main cause of mortality in the post-cardiac arrest period, being as high as 68% after OHCA and 25% after IHCA [4]. These data show that one of our leading goa...

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Early High-Dose Erythropoietin Therapy After Out-of-Hospital Cardiac Arrest

Abstract: In patients resuscitated from an OHCA of presumed cardiac cause, early administration of erythropoietin plus standard therapy did not confer a benefit, and was associated with a higher complication rate. (High Dose of Erythropoietin Analogue After Cardiac Arrest [Epo-ACR-02]; NCT00999583).

Cited by 48 publications

References 32 publications

Erythropoietin therapy after out-of-hospital cardiac arrest: A systematic review and meta-analysis

Erythropoietin therapy after out-of-hospital cardiac arrest: A systematic review and meta-analysis

Comprehensive review of cardiovascular toxicity of drugs and related agents

Strategies of Neuroprotection after Successful Resuscitation

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