Predictors of response to peri-arrest bolus epinephrine in children

To explore clinical characteristics associated with hemodynamic response to initial dosing of peri-arrest bolus epinephrine (PBE) for acute hypotension in the PICU.

Single center retrospective cohort study of patients < 19 years old who received PBE for acute hypotension in the pediatric intensive care units at our institution from April 2017 to September 2023. Change in systolic blood pressure (SBP) was measured within 5 min before and after PBE. Patients were categorized as non-responders if the change in SBP was ≤ 10 mmHg. The primary analysis used a multivariate logistic regression model to determine factors associated with responder status via manual backward stepwise regression. Post-hoc analyses using Pearson correlation assessed the relationship of age, PBE dose, and SBP and DBP response as continuous variables.

Of the 180 patients analyzed, 121 (67 %) were classified as responders and 59 (33%) as non-responders. In the multivariate analysis, non-responder status was independently associated with presence of invasive mechanical ventilation (aOR 5.00; 95 % CI: 1.33, 20; p = 0.017) and acute cardiogenic shock preceding PBE administration (aOR 2.94; 95 % CI:,1.14, 7.69; p = 0.025). In the post hoc analyses, change in SBP was significantly correlated with increasing age (r = 0.27, p = 0.004), and age was inversely correlated with PBE dose by weight (r = -0.50, p < 0.001).

Presence of invasive mechanical ventilation and cardiogenic shock were associated with poor response to PBE. As a continuous variable, SBP response to PBE improved with increasing age despite lower weight-based PBE dosing.