RATIONALE
Animal studies of cardiac arrest suggest shorter epinephrine dosing intervals than currently recommended (every 3-5 minutes) may be beneficial in select circumstances.
OBJECTIVES
To evaluate the association between epinephrine dosing intervals and pediatric cardiac arrest outcomes.
METHODS
Single-center retrospective cohort study of children (<18 years of age) who received ≥1 minute of cardiopulmonary resuscitation and ≥2 doses of epinephrine for an index in-hospital cardiac arrest. Exposure was epinephrine dosing interval: ≤2 minutes (frequent epinephrine) vs. >2 minutes. Primary outcome was survival to hospital discharge with a favorable neurobehavioral outcome (Pediatric Cerebral Performance Category score 1-2 or unchanged). Logistic regression evaluated the association between dosing interval and outcomes; additional analyses explored duration of CPR as a mediator. In a subgroup, the effect of dosing interval on diastolic blood pressure was investigated.
MEASUREMENTS AND MAIN RESULTS
Between January 2011 and December 2018, 125 patients met inclusion/exclusion criteria; 33 (26%) received frequent epinephrine. Frequent epinephrine was associated with increased odds of survival with favorable neurobehavioral outcome (aOR 2.56; CI95 1.07, 6.14; p=0.036), with 66% of the association mediated by CPR duration. Delta diastolic blood pressure was greater after the second dose of epinephrine among patients who received frequent epinephrine (median [IQR] 6.3 [4.1, 16.9] vs. 0.13 [-2.3, 1.9] mmHg, p=0.034).
CONCLUSIONS
In patients who received at least two doses of epinephrine, dosing intervals ≤2 minutes were associated with improved neurobehavioral outcomes compared to dosing intervals >2 minutes. Mediation analysis suggests improved outcomes are largely due to frequent epinephrine shortening duration of CPR.