Inhaled nitric oxide in adults with in-hospital cardiac arrest: A feasibility study

• Published in: Nitric oxide Vol. 115; pp. 30 - 33
• Main Authors: Patel, Jignesh K., Schoenfeld, Elinor, Hou, Wei, Singer, Adam, Rakowski, Ewa, Ahmad, Sahar, Patel, Rajeev, Parikh, Puja B., Smaldone, Gerald
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2021
• Subjects: Administration, Inhalation; Aged; Cardiac arrest; Feasibility Studies; Female; Heart Arrest - drug therapy; Hospitals; Humans; Male; Middle Aged; Mortality; Neurological outcomes; Nitric oxide; Nitric Oxide - administration & dosage; Nitric Oxide - therapeutic use; Outcomes; Pilot Projects; Prospective Studies; Survival; Neurological outcomes; PS; CPR; Mortality; Cardiac arrest; GOS; iNO; ROSC; PPM; Survival; I/R; Outcomes; OHCA; Nitric oxide; ACLS; PCI; CA; IHCA
• ISSN: 1089-8603; 1089-8611
• DOI: 10.1016/j.niox.2021.07.001

While inhaled nitric oxide (iNO) has revealed benefit in cardiac arrest in an animal model, no published data has yet demonstrated the impact of iNO in humans with cardiac arrest. In this pilot study, we administered iNO, along with standard post-resuscitative care, in adults with in-hospital cardiac arrest (IHCA) following achievement of return of spontaneous circulation (ROSC) at an academic tertiary medical center. Patients receiving iNO were compared to age-matched controls with IHCA receiving standard care from an institutional registry. The primary outcome was survival to discharge; secondary outcome was favorable neurologic outcome, defined by a Glasgow Outcome Score of 4 or 5. Propensity-score (PS) matching analysis was performed between patients receiving iNO versus controls. Twenty adults with IHCA receiving iNO were compared to 199 controls with IHCA. Similar age, Charlson comorbidity index, and initial rhythm were noted in both groups. Patients receiving iNO had higher rates of survival to discharge compared to controls (35% vs 11%, p < 0.0001) but no difference in favorable neurologic outcome (15% vs 9%, p = 0.39) in the unmatched population. In the PS-matched analysis, patients receiving iNO had higher survival to discharge (35% vs 20%, p = 0.0344) than the control group but no difference in favorable neurologic outcome (15% vs 20%, p = 0.13) were noted between both groups. In this pilot study, iNO was associated with significantly higher rates of survival to discharge but not favorable neurologic outcome among patients with IHCA compared to controls. This benefit was also observed in the PS-matched analysis. A large scale randomized controlled trial comparing standard of care supplemented with iNO to standard of care alone is warranted in patients with cardiac arrest (Funded by Stony Brook University Renaissance School of Medicine, ClinicalTrials.gov number, NCT04134078). •No published data has yet studied the impact of inhaled nitric oxide (iNO) in humans with in-hospital cardiac arrest (IHCA).•iNO administration is feasible in IHCA and is associated with higher rates of survival to discharge versus controls.•Large scale randomized controlled trials assessing the impact of iNO in the cardiac arrest population are warranted.