Delay to Epinephrine Linked with Worse Outcomes in Children with In-Hospital Cardiac Arrest

August 25, 2015

Delay to Epinephrine Linked with Worse Outcomes in Children with In-Hospital Cardiac Arrest

  1. Katherine Bakes, MD

Among children with nonshockable rhythms, longer time to epinephrine administration was associated with lower likelihood of return of spontaneous circulation, survival at 24 hours, and survival to discharge with favorable neurologic outcome.

  1. Katherine Bakes, MD

Using data from the national Get With the Guidelines–Resuscitation registry from 2000 to 2014, investigators evaluated the effect of time to administration of first epinephrine dose on outcomes in children (age <18 years) with in-hospital cardiac arrest and initial nonshockable rhythms. Patients with trauma and those with cardiac arrest in the delivery room were excluded.

Of 1558 children (median age, 9 months), 64% had return of spontaneous circulation (ROSC), 48% were alive at 24 hours, 31% survived to hospital discharge, and 16% survived with favorable neurological outcome (no or mild cerebral disability). Time to the first epinephrine dose ranged from 0 to 20 minutes (median time, 1 minute). In multivariable analyses adjusting for potential confounders (e.g., age, location of arrest, reason for admission, level of monitoring), each 1-minute delay was independently associated with a decreased chance of ROSC (relative risk, 0.97), survival to 24 hours (RR, 0.97), survival to discharge (RR, 0.95), and survival with favorable neurologic outcome (RR, 0.95). Patients who received the first dose more than 5 minutes after loss of pulse, compared with those who received it earlier, had a significantly lower chance of ROSC (RR, 0.85), 24-hour survival (RR, 0.79), and survival to discharge (RR, 0.75).

Comment

Given that patients were not randomized to receive epinephrine at different times, and other components of resuscitation were not accounted for, early epinephrine dosing may represent a surrogate for early well-coordinated resuscitative efforts. Still, in light of the findings, early epinephrine administration should be part of a comprehensive team approach that includes effective early chest compressions, oxygenation and ventilation support, and intravenous fluid resuscitation, when appropriate.

Editor Disclosures at Time of Publication

  • Disclosures for Katherine Bakes, MD at time of publication Grant / Research support Department of Justice Editorial boards Emergency Medicine Secrets (Elsevier)

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