Racial Differences in Outcomes Among Patients With Septic Shock Experiencing Cardiac Arrest During Vasopressor Therapy

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Rationale: Septic shock requiring vasopressor support carries high mortality. Cardiac arrest during vasopressor therapy represents a catastrophic event. Data on racial differences in outcomes after such events, particularly between African American and Caucasian patients, are limited. We compared clinical characteristics and outcomes in African American versus Caucasian patients experiencing cardiac arrest while receiving vasopressors. Methods: We conducted a retrospective cohort study of adult patients with septic shock at a tertiary medical ICU between 2017 and 2024, who received vasopressor support for ≥6 hours and experienced in-hospital cardiac arrest. Patients were stratified by self-reported race (African American vs Caucasian). Baseline demographics, illness severity (APACHE II), vasopressor type and dose prior to arrest, resuscitation details (initial rhythm, CPR duration, ROSC), post-ROSC DNAR transitions, and in-hospital mortality were compared. Continuous variables were analyzed using t-tests or Mann-Whitney U, categorical variables with χ2 or Fisher’s exact tests; significance was set at p < 0.05. Results: A total of 134 patients met the inclusion criteria; 74 African American and 60 Caucasian. African American patients were older (63.1 ± 11.8 vs 58.8 ± 10.9 years; p = 0.03), had higher BMI (33.9 [26.9– 38.5] vs 30.7 [25.9–33.5] kg/m2 ; p = 0.04), higher median APACHE II scores (38 [36–39] vs 36 [34–37]; p = 0.005), and lower platelet counts on the day of arrest (134 [53–147] vs 154 [76–188]×103 /µL; p = 0.04). Median duration on vasopressors prior to arrest was similar (21.4 [12– 24] vs 16 [10–16] hours; p = 0.48). Initial arrest rhythms, CPR duration, and ROSC rates did not differ (51 % vs 48 %; p = 0.73). Post-ROSC transition to DNAR was lower in African American patients (24 % vs 43 %; p = 0.019). In-hospital mortality was uniformly high (97 % vs 95 %; p = 0.49). Conclusions: In septic shock patients experiencing cardiac arrest during vasopressor therapy, outcomes were universally poor. African American patients had higher illness severity but similar resuscitation success and hospital survival compared with Caucasian patients. The lower post-ROSC DNAR transition rate in African American patients may reflect differences in end-of-life decision-making rather than physiological disparity. These findings highlight the need for further study of race-based differences in critical illness care processes.

Volume

212

Issue

S1

First Page

S4666

Last Page

S4666

Comments

American Thoracic Society International Conference, May 15-20, 2026, Orlando, FL

DOI

10.1093/ajrccm/aamag162.6252

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