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Published on: August 30, 2011
Peri-arrest bolus epinephrine practices amongst pediatric resuscitation experts
Catherine E Ross1,2, Margaret M Hayes3, Monica E Kleinman4
1Division of Medicine Critical Care, Department of Pediatrics Boston Children's Hospital and Harvard Medical School, 333 Longwood Avenue, Boston, MA 02115, USA.
Insights
Pediatric resuscitation experts widely use peri-arrest bolus epinephrine, but dosing varies significantly. Further research is needed to standardize practices and determine optimal outcomes for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Resuscitation Science
- Pharmacology
Background:
- Peri-arrest bolus epinephrine is increasingly considered for pediatric patients not requiring cardiopulmonary resuscitation.
- Current expert practices regarding its use and dosing are not well-defined.
- Variability in practice may impact patient outcomes.
Purpose of the Study:
- To describe current practices of peri-arrest bolus epinephrine administration among pediatric resuscitation experts globally.
- To identify variations in dosing strategies and clinician perspectives on evidence supporting its use.
Main Methods:
- A 9-question electronic survey was distributed to pediatric critical care physicians within the Pediatric Resuscitation Quality Collaborative (pediRES-Q) network.
- Responses were linked to institutional data from the American Hospital Association 2018 Annual Survey.
- Descriptive and qualitative content analyses were employed to analyze survey data.
Main Results:
- Of 49 respondents (78% participation rate) from 35 institutions in 9 countries, 94% would consider peri-arrest bolus epinephrine for non-arresting critically ill children.
- Initial weight-based dosing strategies ranged from 0.1 mcg/kg to 10 mcg/kg, with 1 mcg/kg being the most common initial dose.
- A small minority (6%) of participants expressed concerns about the lack of evidence supporting this practice.
Conclusions:
- Peri-arrest bolus epinephrine use is nearly universally endorsed by pediatric resuscitation experts, despite limited supporting evidence cited by some.
- Significant variability exists in reported initial dosing, with a 100-fold range and some non-weight-based approaches.
- Further research is essential to establish best practices, standardize dosing, and evaluate clinical outcomes associated with peri-arrest epinephrine use.
Aim:
To describe current practices of peri-arrest bolus epinephrine use amongst pediatric resuscitation experts in a multinational survey.
Methods:
A 9-question survey was developed and electronically distributed to pediatric critical care physicians who are site investigators for the Pediatric Resuscitation Quality Collaborative (pediRES-Q) network. Institutional demographics were collected through the American Hospital Association 2018 Annual Survey and linked to responses. Descriptive statistics were used to characterize closed-ended responses, and qualitative content analysis to analyze open-ended responses.
Results:
Of the 63 collaborative members invited to participate, 49 (78%) responded, representing 35 institutions in 9 countries. Forty-six of the 49 respondents (94%) reported that they would consider using peri-arrest bolus epinephrine during critical situations in patients not requiring cardiopulmonary resuscitation. Initial dosing strategies ranged from 0.1mcg/kg to 10mcg/kg, with the most commonly reported initial dose of 1mcg/kg by 25 of the 37 (68%) respondents who answered this question. Three of the 49 (6%) participants indicated that they would generally avoid using peri-arrest bolus epinephrine, citing lack of evidence to support its use.
Conclusions:
In this multinational survey of pediatric resuscitation experts, endorsement of peri-arrest bolus epinephrine use was nearly universal, though a few clinicians cited lack of evidence to support this practice. There was a 100-fold difference in the range of initial weight-based doses reported, as well as a minority of clinicians who reported using non-weight-based dosing. Further research is needed to determine best practices, standardization of initial dosing, clinical factors that may warrant dosing modifications and associations with clinically important outcomes.
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