Epinephrine Dosing Intervals Are Associated With Pediatric In-Hospital Cardiac Arrest Outcomes: A Multicenter Study

Martha F. Kienzle, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Ryan W. Morgan, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Ron W. Reeder, Department of Pediatrics, University of Utah, Salt Lake City, UT.
Tageldin Ahmed, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
Robert A. Berg, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Robert Bishop, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Matthew Bochkoris, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Joseph A. Carcillo, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Todd C. Carpenter, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Kellimarie K. Cooper, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
J Wesley Diddle, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Myke Federman, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
Richard Fernandez, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
Deborah Franzon, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
Aisha H. Frazier, Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE.
Stuart H. Friess, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
Meg Frizzola, Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE.
Kathryn Graham, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Mark Hall, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
Christopher Horvat, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Leanna L. Huard, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
Tensing Maa, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
Arushi Manga, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
Patrick S. McQuillen, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
Kathleen L. Meert, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
Peter M. Mourani, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Vinay M. Nadkarni, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Maryam Y. Naim, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Murray M. Pollack, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
Anil Sapru, Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
Carleen Schneiter, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Matthew P. Sharron, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.

Document Type

Journal Article

Publication Date

6-4-2024

Journal

Critical care medicine

DOI

10.1097/CCM.0000000000006334

Abstract

OBJECTIVES: Data to support epinephrine dosing intervals during cardiopulmonary resuscitation (CPR) are conflicting. The objective of this study was to evaluate the association between epinephrine dosing intervals and outcomes. We hypothesized that dosing intervals less than 3 minutes would be associated with improved neurologic survival compared with greater than or equal to 3 minutes. DESIGN: This study is a secondary analysis of The ICU-RESUScitation Project (NCT028374497), a multicenter trial of a quality improvement bundle of physiology-directed CPR training and post-cardiac arrest debriefing. SETTING: Eighteen PICUs and pediatric cardiac ICUs in the United States. PATIENTS: Subjects were 18 years young or younger and 37 weeks old or older corrected gestational age who had an index cardiac arrest. Patients who received less than two doses of epinephrine, received extracorporeal CPR, or had dosing intervals greater than 8 minutes were excluded. INTERVENTIONS: The primary exposure was an epinephrine dosing interval of less than 3 vs. greater than or equal to 3 minutes. MEASUREMENTS AND MAIN RESULTS: The primary outcome was survival to discharge with a favorable neurologic outcome defined as a Pediatric Cerebral Performance Category score of 1-2 or no change from baseline. Regression models evaluated the association between dosing intervals and: 1) survival outcomes and 2) CPR duration. Among 382 patients meeting inclusion and exclusion criteria, median age was 0.9 years (interquartile range 0.3-7.6 yr) and 45% were female. After adjustment for confounders, dosing intervals less than 3 minutes were not associated with survival with favorable neurologic outcome (adjusted relative risk [aRR], 1.10; 95% CI, 0.84-1.46; p = 0.48) but were associated with improved sustained return of spontaneous circulation (ROSC) (aRR, 1.21; 95% CI, 1.07-1.37; p < 0.01) and shorter CPR duration (adjusted effect estimate, -9.5 min; 95% CI, -14.4 to -4.84 min; p < 0.01). CONCLUSIONS: In patients receiving at least two doses of epinephrine, dosing intervals less than 3 minutes were not associated with neurologic outcome but were associated with sustained ROSC and shorter CPR duration.

Department

Pediatrics

Link to Full Text

Share

COinS