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Pediatric timing of epinephrine doses: A systematic review

Shinichiro Ohshimo1, Chih-Hung Wang2, Thomaz Bittencourt Couto3

  • 1Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Resuscitation
|February 2, 2021
PubMed

Insights

Earlier epinephrine administration may improve outcomes for pediatric cardiac arrest. However, the optimal timing for epinephrine delivery in children remains undetermined due to limited evidence and confounding factors.

Area of Science:

  • Pediatric Resuscitation Science
  • Emergency Medicine
  • Clinical Pharmacology

Background:

  • Pediatric cardiac arrest (PCA) requires timely interventions, including epinephrine administration.
  • Optimal timing and dosing of epinephrine in pediatric resuscitation remain debated.
  • Evidence quality for pediatric resuscitation guidelines is often low.

Purpose of the Study:

  • To evaluate the optimal timing and doses of epinephrine for infants and children experiencing in-hospital or out-of-hospital cardiac arrest.
  • To synthesize current evidence on epinephrine administration in pediatric cardiac arrest.

Main Methods:

  • Systematic literature search of Medline, EMBASE, and CENTRAL for randomized clinical trials and observational studies.
  • Meta-analysis of 7 observational studies, with risk of bias assessment using GRADE and CLARITY frameworks.
  • Contacting study authors for additional data on critically important outcomes.

Main Results:

  • No randomized clinical trials were identified; 7 observational studies were included in the meta-analysis.
  • The overall certainty of evidence was very low.
  • Earlier epinephrine administration showed a favorable trend for both in-hospital and out-of-hospital pediatric cardiac arrest, but optimal intervals could not be determined.

Conclusions:

  • Earlier administration of the first epinephrine dose may be beneficial in non-shockable pediatric cardiac arrest.
  • The optimal interval for epinephrine administration in pediatric cardiac arrest remains unclear due to study limitations.
Abstract

Keywords:
ChildrenGood neurological outcomeHospital dischargeInfantROSCSurvival

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