Epinephrine Dosing Intervals Are Associated With Pediatric Cardiac Arrest Outcomes
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Resuscitation, Pharmacology, Pediatrics, 2022
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INTRODUCTION: In a single-center observational study, epinephrine administered more frequently than recommended by the American Heart Association (≤2 minutes) was associated with improved outcomes from pediatric in-hospital cardiac arrest (p-IHCA). The objective of this study was to evaluate the association between epinephrine dosing intervals and outcomes in a multicenter study. We hypothesized that dosing intervals ≤2 minutes would be associated with survival compared to >2 minutes. METHODS: Subjects were children ≤18 years old and ≥37 weeks corrected gestational age who had an index cardiac arrest while admitted to one of the 18 participating ICUs of The ICU-RESUScitation Project (NCT028374497), a multicenter, cluster randomized interventional trial. Patients who received < 2 doses of epinephrine, received extracorporeal cardiopulmonary resuscitation (ECPR) or had a dosing interval >8 minutes were excluded (presumed intermittent return of spontaneous circulation [ROSC]). Frequent epinephrine was defined as an interval ≤2 minutes. Regression models evaluated the association between frequent epinephrine and 1) outcomes and 2) CPR duration. The primary outcome was survival with favorable neurobehavioral outcome (Pediatric Cerebral Performance Category score 1-3 or no change from baseline).   RESULTS: Among 383 patients meeting inclusion and exclusion criteria, 200 (52%) were less than 1 year of age, 168 (44%) survived to hospital discharge and 157 (41%) survived with favorable neurobehavioral outcome. Fifty-four (14%) received frequent epinephrine. After adjustment for illness category, age, first documented rhythm, weekday vs night/weekend, clinical site, time to first epinephrine dose and Pediatric Risk of Mortality (PRISM) score, frequent epinephrine was not associated with survival with favorable neurobehavioral outcome (aOR 1.23, 95CI 0.92, 1.69, p = 0.18) or survival to discharge (aOR 1.19, CI95 0.89, 1.59, p = 0.26) but was associated with higher rates of ROSC (aOR 1.32, CI95 1.18, 1.48, p < 0.01) and shorter CPR duration (adjusted effect estimate -15.1 minutes, CI95 -20.9, -9.35, p < 0.01). CONCLUSIONS: In patients receiving at least two doses of epinephrine, frequent epinephrine was not associated with improved neurobehavioral outcome but was associated with improved odds of ROSC and shorter CPR duration.
Meta Tag
Content Type Presentation
Knowledge Area Resuscitation
Knowledge Area Pharmacology
Knowledge Area Pediatrics
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Cardiac Arrest
Tag Pharmacology
Tag Pediatrics
Tag Cardiopulmonary Resuscitation CPR
Year 2022
pediatric in-hospital cardiac arrest
dosing intervals
survival outcomes


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