High Dose Vasopressor Exposure at Time of In-Hospital Cardiac Arrest: Eight-Year Outcomes From a Michigan Tertiary Care Cohort

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Rationale: High-dose vasopressor therapy (HDVT) is essential to support patients with refractory septic shock who remain profoundly vasoplegic despite standard therapy. Higher vasopressor doses, prolonged infusion time, and multi-agent vasopressor use have been associated with increased mortality in critically ill patients. However, outcomes following in-hospital cardiac arrest and cardiopulmonary resuscitation (CPR) in patients receiving HDVT are not well described. Improved understanding is needed to help clinicians evaluate resuscitation benefit in this advanced stage of shock physiology. Methods: We conducted a retrospective cohort study of adult patients with septic shock who developed in-hospital cardiac arrest and received CPR in a tertiary medical ICU between 2017 and 2024. Patients were grouped by vasopressor exposure at the time of arrest: HDVT (≥1 µg/kg/min norepinephrine-equivalent; n = 90) versus non-HDVT (0.01-0.99 µg/kg/min; n = 59). Demographics, comorbidities, SOFA score, peak lactate, vasopressor requirements, arrest rhythms, and clinical outcomes were collected. Continuous and categorical variables were compared using Mann-Whitney U and chi-square or Fisher exact tests, respectively. Outcomes included return of spontaneous circulation (ROSC) and in-hospital mortality. Results: A total of 149 patients met inclusion criteria. Age (62 vs 61 years; p = 0.62) and comorbidity burden (CCI 6 vs 5; p = 0.14) were similar between groups. Patients receiving HDVT demonstrated greater shock severity, including higher SOFA score (15 vs 14; p < 0.001), peak lactate (16 vs 11.77 mmol/L; p = < 0.001), and cumulative norepinephrine equivalent (1.81 vs 0.54 µg/kg/min; p < 0.0001). Pulseless electrical activity was the predominant rhythm in both groups (55.6% vs 54.2%; p = 0.87). ROSC rates were comparable (54.4% vs 50.8%; p = 0.67). In-hospital mortality was 100% in the HDVT group versus 91.5% in the non-HDVT group. Conclusions: This study demonstrated that septic shock patients who experienced cardiac arrest while receiving high-dose vasopressor therapy had universal in-hospital mortality, despite similar arrest rhythms and CPR success when compared with patients on lower vasopressor doses. These findings suggest that escalation to HDVT at the time of cardiac arrest may indicate a point of irreversible circulatory failure where continued resuscitative efforts are unlikely to change outcomes. Future multicenter studies are needed to validate these results and guide early, informed goals-of-care discussions in patients with severe septic shock.

Volume

212

Issue

S1

First Page

S3620

Last Page

S3620

Comments

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

DOI

10.1093/ajrccm/aamag162.4807

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