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Epinephrine in pediatric cardiorespiratory arrest: when and how much?
João Carlos Pina Faria1,2, Camila Augusta Victorino2, Monica Akemi Sato1
1Faculdade de Medicina do ABC, Centro Universitário Saúde ABC, Santo André, SP, Brazil.
Insights
Early epinephrine administration and standard doses improve survival in pediatric cardiorespiratory arrest. Larger intervals between doses and fewer administrations are associated with better outcomes for children and adolescents.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Critical Care Medicine
Background:
- Cardiorespiratory arrest (CRA) in children and adolescents presents unique challenges.
- Optimizing epinephrine administration is crucial for improving survival rates.
Purpose of the Study:
- To evaluate the impact of varying epinephrine doses, timing, and frequency on survival in pediatric CRA.
- To compare different dosing strategies against current recommendations.
Main Methods:
- Systematic review of studies published between 2000 and 2019 from PubMed/MEDLINE.
- Inclusion criteria focused on patients under 18 years experiencing CRA.
- Analysis of 16 selected articles from an initial pool of 222.
Main Results:
- Immediate administration of the first epinephrine dose is recommended.
- The standard dose (0.01mg/kg) demonstrated superior outcomes compared to a higher dose (0.1mg/kg).
- Increased epinephrine doses and shorter intervals between doses correlated with decreased survival rates.
Conclusions:
- The standard epinephrine dose and prompt administration are key for pediatric CRA survival.
- Current recommended intervals and maximum dose limits require further investigation for optimal outcomes.
Abstract:
The objective of the present study was to assess the efficacy of different doses, times for infusion of the first dose, intervals of administration of subsequent doses, and number of epinephrine doses in the survival of children and adolescents who went into cardiorespiratory arrest. It is a review study with data from the PubMedⓇ/MEDLINEⓇdatabase. The search was for articles published from January 1st, 2000 to February 10, 2019, with a sample of patients aged under 18 years, published in English, Portuguese and Spanish. We found 222 articles, of which 16 met the inclusion criteria of the study. The first dose should be given as soon as possible. The standard dose (0.01mg/kg) has a better outcome when compared to the higher dose (0.1mg/kg). There is an iⓇverse relation between the number of epinephrine doses and survival. The interval currently recommended between doses has lower survival when compared to larger intervals. The dosage recommended by the American Heart Association presents a better outcome for survival, but the interval between doses and the maximum number of doses should be better assessed.
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