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Time to Epinephrine and Survival After Pediatric In-Hospital Cardiac Arrest
Lars W Andersen1, Katherine M Berg2, Brian Z Saindon3
1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts2Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Delaying epinephrine in pediatric cardiac arrest lowers survival chances. Prompt administration is crucial for better outcomes in children experiencing nonshockable rhythms during in-hospital events.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiology
- Emergency Medicine
Background:
- Delayed epinephrine administration is linked to reduced survival in adult in-hospital cardiac arrest with nonshockable rhythms.
- The impact of epinephrine timing on pediatric outcomes after in-hospital cardiac arrest is not well-established.
Purpose of the Study:
- To investigate the association between the time to the first epinephrine dose and patient outcomes in pediatric in-hospital cardiac arrest.
- To determine if delayed epinephrine administration impacts survival and neurological function in pediatric patients.
Main Methods:
- Analysis of data from the Get With the Guidelines-Resuscitation registry.
- Inclusion of US pediatric patients (<18 years) with in-hospital cardiac arrest and initial nonshockable rhythm receiving epinephrine.
- Evaluation of survival to discharge, return of spontaneous circulation (ROSC), 24-hour survival, and neurological outcomes.
Main Results:
- Longer time to epinephrine was associated with decreased survival to hospital discharge (RR per minute delay, 0.95).
- Delayed epinephrine administration correlated with lower rates of ROSC, 24-hour survival, and favorable neurological outcomes.
- Patients receiving epinephrine >5 minutes after pulse loss had significantly lower in-hospital survival (21.0%) compared to those receiving it within 5 minutes (33.1%).
Conclusions:
- In pediatric in-hospital cardiac arrest with nonshockable rhythms, delayed epinephrine administration is associated with poorer survival outcomes.
- Prompt epinephrine delivery is critical for improving survival rates and neurological recovery in pediatric cardiac arrest patients.
- This study highlights the importance of timely interventions in pediatric resuscitation efforts.
Importance:
Delay in administration of the first epinephrine dose is associated with decreased survival among adults after in-hospital, nonshockable cardiac arrest. Whether this association is true in the pediatric in-hospital cardiac arrest population remains unknown.
Objective:
To determine whether time to first epinephrine dose is associated with outcomes in pediatric in-hospital cardiac arrest.
Design, Setting And Participants:
We performed an analysis of data from the Get With the Guidelines-Resuscitation registry. We included US pediatric patients (age <18 years) with an in-hospital cardiac arrest and an initial nonshockable rhythm who received at least 1 dose of epinephrine. A total of 1558 patients (median age, 9 months [interquartile range [IQR], 13 days-5 years]) were included in the final cohort.
Exposure:
Time to epinephrine, defined as time in minutes from recognition of loss of pulse to the first dose of epinephrine.
Main Outcomes And Measures:
The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC), survival at 24 hours, and neurological outcome. A favorable neurological outcome was defined as a score of 1 to 2 on the Pediatric Cerebral Performance Category scale.
Results:
Among the 1558 patients, 487 (31.3%) survived to hospital discharge. The median time to first epinephrine dose was 1 minute (IQR, 0-4; range, 0-20; mean [SD], 2.6 [3.4] minutes). Longer time to epinephrine administration was associated with lower risk of survival to discharge in multivariable analysis (multivariable-adjusted risk ratio [RR] per minute delay, 0.95 [95% CI, 0.93-0.98]). Longer time to epinephrine administration was also associated with decreased risk of ROSC (multivariable-adjusted RR per minute delay, 0.97 [95% CI, 0.96-0.99]), decreased risk of survival at 24 hours (multivariable-adjusted RR per minute delay, 0.97 [95% CI, 0.95-0.99]), and decreased risk of survival with favorable neurological outcome (multivariable-adjusted RR per minute delay, 0.95 [95% CI, 0.91-0.99]). Patients with time to epinephrine administration of longer than 5 minutes (233/1558) compared with those with time to epinephrine of 5 minutes or less (1325/1558) had lower risk of in-hospital survival to discharge (21.0% [49/233] vs 33.1% [438/1325]; multivariable-adjusted RR, 0.75 [95% CI, 0.60-0.93]; P = .01).
Conclusions And Relevance:
Among children with in-hospital cardiac arrest with an initial nonshockable rhythm who received epinephrine, delay in administration of epinephrine was associated with decreased chance of survival to hospital discharge, ROSC, 24-hour survival, and survival to hospital discharge with a favorable neurological outcome.
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