Prevalence and characteristics of metaraminol usage in a large intensive care patient cohort. A multicentre, retrospective, observational study

TL;DR

This study examines how often metaraminol is used in ICU patients and finds that it's given to a smaller group of less critically ill patients compared to noradrenaline.

Contribution

The study provides new insights into the real-world usage patterns and patient characteristics associated with metaraminol in ICU settings.

Findings

Metaraminol was administered to 11.3% of ICU patients receiving single-agent vasopressor therapy.

Patients receiving metaraminol were less likely to have ischaemic heart disease and higher APACHE III scores compared to noradrenaline users.

Most metaraminol patients did not convert to noradrenaline infusion, and factors like after-hours admission and regional ICU location were linked to its use.

Abstract

Noradrenaline is the most prescribed vasopressor in intensive care units (ICUs). Although there is limited supporting evidence, metaraminol is often used as an alternative agent in some regions. We aimed to describe current practice and elucidate the factors associated with metaraminol prescription in a large cohort of ICU patients.

A multicenter, retrospective cohort study of granular, routinely collected electronic medical record–based clinical data was performed in 12 ICUs in Queensland, Australia, between January 1, 2015, and December 31, 2021. Patients who received at least four consecutive hours of either metaraminol or noradrenaline in the first 24 h of their ICU stay were included.

In total, 17,432 patients received single-agent vasopressor therapy and 1,963 (11.3 %) patients were administered metaraminol. For the entire cohort, the median age was 61 (interquartile range, IQR: 47–71), and the median Charlson Comorbidity Index was 3 (IQR: 1–5). The patients who received metaraminol had less ischaemic heart disease (5.5 % vs 7.6 %; p < 0.001) and were more likely to have localised cancer (16 % vs 14 %; p < 0.004). The patients receiving metaraminol were less likely to be ventilated on admission (39 % vs 73 %; p < 0.001) and had lower median Acute Physiology and Chronic Health Evaluation III scores (51 vs 56; p < 0.001). The median duration of metaraminol was 10 h (IQR: 6–18) and two-thirds (65 %) did not convert to noradrenaline infusion. After adjustment for confounders, after-hours admission (odds ratio, OR: 1.55; 95 % confidence interval [CI]: 1.40–1.71; p < 0.001), treatment limitation orders (OR: 1.35; 95 % CI: 1.10–1.64; p < 0.004), and admission to a regional ICU (OR: 1.47; 95 % CI: 1.27–1.68; p < 0.001) were independently associated with metaraminol use.

Metaraminol is a widely used vasoconstrictor in Queensland ICUs. Patients who receive metaraminol have specific characteristics but are overall less unwell than patients who receive noradrenaline. Most patients who receive metaraminol do not require an alternative vasoactive medication.

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