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Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest

Derek B Hoyme1, Sonali S Patel2, Ricardo A Samson3

  • 1Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA, United States.

Resuscitation
|May 30, 2017
PubMed

Insights

Longer epinephrine dosing intervals during pediatric in-hospital cardiac arrest (IHCA) are linked to better survival rates. This finding challenges current guidelines recommending shorter intervals for improved outcomes in children.

Area of Science:

  • Pediatric critical care medicine
  • Cardiopulmonary resuscitation research
  • Clinical trial methodology

Background:

  • Current guidelines suggest epinephrine administration every 3-5 minutes during cardiopulmonary resuscitation.
  • Previous studies in adults with in-hospital cardiac arrest (IHCA) indicate that longer epinephrine dosing intervals correlate with improved survival to discharge.
  • The efficacy of extended epinephrine dosing intervals in pediatric IHCA remains to be fully elucidated.

Purpose of the Study:

  • To investigate the association between longer epinephrine dosing intervals and survival to hospital discharge in pediatric patients experiencing in-hospital cardiac arrest (IHCA).
  • To evaluate if extending epinephrine dosing intervals beyond current recommendations impacts survival outcomes in pediatric IHCA cases.

Main Methods:

  • A retrospective analysis was conducted using the AHA Get With The Guidelines-Resuscitation registry, including 1630 pediatric IHCAs.
  • Epinephrine dosing intervals were calculated by dividing the resuscitation duration by the number of doses administered, categorized into 1-5 min, >5 to <8 min, and 8 to <10 min per dose.
  • Multivariable logistic regression models were employed to control for various confounding factors, with a secondary analysis stratifying patients based on vasoactive infusion status at the time of arrest.

Main Results:

  • For the overall cohort, adjusted odds ratios for survival to hospital discharge were 1.81 (95% CI 1.26-2.59) for >5 to <8 min intervals and 2.64 (95% CI 1.53-4.55) for 8 to <10 min intervals, compared to the 1-5 min reference.
  • In patients not receiving vasoactive infusions, adjusted odds ratios for survival were 1.99 (95% CI 1.29-3.06) for >5 to <8 min intervals and 2.67 (95% CI 1.14-5.04) for 8 to <10 min intervals.
  • These results indicate a statistically significant association between longer epinephrine dosing intervals and improved survival rates.

Conclusions:

  • Longer average epinephrine dosing intervals during pediatric in-hospital cardiac arrest (IHCA) are associated with enhanced survival to hospital discharge.
  • The findings suggest a potential need to re-evaluate current epinephrine administration guidelines for pediatric IHCA.
  • Extended epinephrine dosing intervals may represent a viable strategy to improve outcomes in pediatric cardiac arrest resuscitation.
Abstract

Keywords:
American Heart AssociationCardiopulmonary resuscitationChildEpinephrineHumansIn-hospital cardiac arrestRegistriesRetrospective studiesVasoconstrictor agents

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