Epinephrine Versus Dopamine in Children, What Is the Current Evidence and What Do We Need? A Systematic Review and
Rohit S Loomba1,2, Riddhi D Patel1, Enrique G Villarreal3
1Division of Pediatric Cardiac Critical Care (RSL, RDP), Advocate Children's Hospital, Oak Lawn, IL.
Insights
Epinephrine use in pediatric patients showed a mortality benefit compared to dopamine. Further research is needed to fully understand comparative effects of these vasoactive agents.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Cardiovascular research
Background:
- Vasoactive agents are crucial for pediatric patients post-cardiothoracic surgery or in shock.
- Current clinical practices for vasoactive agents rely on limited evidence and anecdotal observations.
- Comparative studies on vasoactive agents in pediatric populations are scarce.
Purpose of the Study:
- To systematically review and quantify the comparative effects of epinephrine and dopamine in pediatric patients.
- To identify knowledge gaps in the use of these vasoactive agents.
Main Methods:
- A systematic review of full-text English manuscripts from PubMed, Embase, and Cochrane databases.
- Inclusion criteria required clinical data comparing dopamine and epinephrine for the same endpoints.
- Analysis included data from 5 studies with 397 pediatric patients.
Main Results:
- Epinephrine use was associated with significantly lower mortality compared to dopamine (risk ratio, 0.74).
- In neonatal subgroup analysis, epinephrine showed a higher average heart rate and lower average mean arterial blood pressure.
- Data from 397 patients (187 epinephrine, 210 dopamine) were analyzed.
Conclusions:
- Limited data exist comparing dopamine and epinephrine in pediatric patients.
- Available evidence suggests a potential mortality benefit with epinephrine use.
- Further research is warranted to elucidate comparative effects and optimize pediatric vasoactive agent therapy.
Introduction:
Pediatric patients often receive vasoactive agents following cardiothoracic surgery or when in shock. The use of vasoactive agents varies between different settings and has largely changed because of anecdotal observations or small observational studies. Although vasoactive agents are frequently used, there are limited studies in pediatric populations comparing them to one another. The purpose of this systematic review is to quantify the comparative effects of epinephrine and dopamine while identifying gaps in knowledge.
Methods:
A systematic review of published manuscripts was completed to identify full-text manuscripts in English using PubMed, Embase, and Cochrane databases. Studies were included if they included clinical data using dopamine and epinephrine in different patients and included data for the same end points for patients receiving epinephrine or dopamine.
Results:
A total of 5 studies with 397 patients were included. Of the included patients, 187 received epinephrine and 210 received dopamine. The mean age for all the patients was 45 months. When all patient data were pooled, a significantly lower mortality was associated with epinephrine compared with dopamine (risk ratio, 0.74; 95% CI, 0.55-0.99). When only neonatal data were pooled, epinephrine was associated with a significantly higher average heart rate (10 bpm; 95% CI, 2.0-18.7) and a significantly lower average mean arterial blood pressure (-2.5 mm Hg; 95% CI, -4.6 to -0.4).
Conclusion:
Limited data are available comparing dopamine to epinephrine in pediatric patients. The -available data demonstrate an apparent mortality benefit associated with the use of epinephrine.
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