Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest

the American Heart Association Get With the Guidelines–Resuscitation Investigators

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Current guidelines recommend epinephrine every 3–5 min during cardiopulmonary resuscitation. For adults with in-hospital cardiac arrest (IHCA), longer dosing intervals are associated with improved survival to discharge. This study investigates whether longer epinephrine dosing intervals were associated with improved survival to discharge during pediatric IHCA. Methods Retrospective review of AHA Get With The Guidelines-Resuscitation registry identified 1630 pediatric IHCAs that met inclusion criteria. Average epinephrine dosing interval was defined by dividing duration of resuscitation after first dose of epinephrine by total doses. Average dosing intervals were categorized as 1–5 min, >5 to <8 min, and 8 to <10 min/dose. Primary outcome was survival to hospital discharge. Multivariable logistic regression models controlled for age, gender, illness category, location of arrest, arrest duration, time of day, and time to first epinephrine dose. Secondary analysis separated patients on vasoactive infusion at the time of arrest from those without an infusion in place. Results Odds ratios (OR) calculated using 1–5 min/dose interval as reference. For the total cohort, adjusted OR for survival to hospital discharge for >5 to <8 min was 1.81 (95% CI 1.26–2.59), and 8 to <10 min 2.64 (95% CI 1.53–4.55). For patients not receiving vasoactive infusion, adjusted OR for survival to discharge for >5 to <8 min was 1.99 (95% CI 1.29-3.06) and 8 to <10 min 2.67 (95% CI 1.14–5.04). Conclusions Longer average dosing intervals than currently recommended for epinephrine administration during pediatric IHCA were associated with improved survival to hospital discharge.

Original languageEnglish (US)
Pages (from-to)18-23
Number of pages6
JournalResuscitation
Volume117
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Pediatric Hospitals
Heart Arrest
Epinephrine
Resuscitation
Guidelines
Cardiopulmonary Resuscitation
Registries
Pediatrics

Keywords

  • American Heart Association
  • Cardiopulmonary resuscitation
  • Child
  • Epinephrine
  • Humans
  • In-hospital cardiac arrest
  • Registries
  • Retrospective studies
  • Vasoconstrictor agents

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

the American Heart Association Get With the Guidelines–Resuscitation Investigators (2017). Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest. Resuscitation, 117, 18-23. https://doi.org/10.1016/j.resuscitation.2017.05.023

Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest. / the American Heart Association Get With the Guidelines–Resuscitation Investigators.

In: Resuscitation, Vol. 117, 01.08.2017, p. 18-23.

Research output: Contribution to journalArticle

the American Heart Association Get With the Guidelines–Resuscitation Investigators 2017, 'Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest', Resuscitation, vol. 117, pp. 18-23. https://doi.org/10.1016/j.resuscitation.2017.05.023
the American Heart Association Get With the Guidelines–Resuscitation Investigators. Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest. Resuscitation. 2017 Aug 1;117:18-23. https://doi.org/10.1016/j.resuscitation.2017.05.023
the American Heart Association Get With the Guidelines–Resuscitation Investigators. / Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest. In: Resuscitation. 2017 ; Vol. 117. pp. 18-23.
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abstract = "Background Current guidelines recommend epinephrine every 3–5 min during cardiopulmonary resuscitation. For adults with in-hospital cardiac arrest (IHCA), longer dosing intervals are associated with improved survival to discharge. This study investigates whether longer epinephrine dosing intervals were associated with improved survival to discharge during pediatric IHCA. Methods Retrospective review of AHA Get With The Guidelines-Resuscitation registry identified 1630 pediatric IHCAs that met inclusion criteria. Average epinephrine dosing interval was defined by dividing duration of resuscitation after first dose of epinephrine by total doses. Average dosing intervals were categorized as 1–5 min, >5 to <8 min, and 8 to <10 min/dose. Primary outcome was survival to hospital discharge. Multivariable logistic regression models controlled for age, gender, illness category, location of arrest, arrest duration, time of day, and time to first epinephrine dose. Secondary analysis separated patients on vasoactive infusion at the time of arrest from those without an infusion in place. Results Odds ratios (OR) calculated using 1–5 min/dose interval as reference. For the total cohort, adjusted OR for survival to hospital discharge for >5 to <8 min was 1.81 (95{\%} CI 1.26–2.59), and 8 to <10 min 2.64 (95{\%} CI 1.53–4.55). For patients not receiving vasoactive infusion, adjusted OR for survival to discharge for >5 to <8 min was 1.99 (95{\%} CI 1.29-3.06) and 8 to <10 min 2.67 (95{\%} CI 1.14–5.04). Conclusions Longer average dosing intervals than currently recommended for epinephrine administration during pediatric IHCA were associated with improved survival to hospital discharge.",
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author = "{the American Heart Association Get With the Guidelines–Resuscitation Investigators} and Hoyme, {Derek B.} and Patel, {Sonali S.} and Samson, {Ricardo A} and Raymond, {Tia T.} and Nadkarni, {Vinay M.} and Gaies, {Michael G.} and Atkins, {Dianne L.}",
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T1 - Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest

AU - the American Heart Association Get With the Guidelines–Resuscitation Investigators

AU - Hoyme, Derek B.

AU - Patel, Sonali S.

AU - Samson, Ricardo A

AU - Raymond, Tia T.

AU - Nadkarni, Vinay M.

AU - Gaies, Michael G.

AU - Atkins, Dianne L.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background Current guidelines recommend epinephrine every 3–5 min during cardiopulmonary resuscitation. For adults with in-hospital cardiac arrest (IHCA), longer dosing intervals are associated with improved survival to discharge. This study investigates whether longer epinephrine dosing intervals were associated with improved survival to discharge during pediatric IHCA. Methods Retrospective review of AHA Get With The Guidelines-Resuscitation registry identified 1630 pediatric IHCAs that met inclusion criteria. Average epinephrine dosing interval was defined by dividing duration of resuscitation after first dose of epinephrine by total doses. Average dosing intervals were categorized as 1–5 min, >5 to <8 min, and 8 to <10 min/dose. Primary outcome was survival to hospital discharge. Multivariable logistic regression models controlled for age, gender, illness category, location of arrest, arrest duration, time of day, and time to first epinephrine dose. Secondary analysis separated patients on vasoactive infusion at the time of arrest from those without an infusion in place. Results Odds ratios (OR) calculated using 1–5 min/dose interval as reference. For the total cohort, adjusted OR for survival to hospital discharge for >5 to <8 min was 1.81 (95% CI 1.26–2.59), and 8 to <10 min 2.64 (95% CI 1.53–4.55). For patients not receiving vasoactive infusion, adjusted OR for survival to discharge for >5 to <8 min was 1.99 (95% CI 1.29-3.06) and 8 to <10 min 2.67 (95% CI 1.14–5.04). Conclusions Longer average dosing intervals than currently recommended for epinephrine administration during pediatric IHCA were associated with improved survival to hospital discharge.

AB - Background Current guidelines recommend epinephrine every 3–5 min during cardiopulmonary resuscitation. For adults with in-hospital cardiac arrest (IHCA), longer dosing intervals are associated with improved survival to discharge. This study investigates whether longer epinephrine dosing intervals were associated with improved survival to discharge during pediatric IHCA. Methods Retrospective review of AHA Get With The Guidelines-Resuscitation registry identified 1630 pediatric IHCAs that met inclusion criteria. Average epinephrine dosing interval was defined by dividing duration of resuscitation after first dose of epinephrine by total doses. Average dosing intervals were categorized as 1–5 min, >5 to <8 min, and 8 to <10 min/dose. Primary outcome was survival to hospital discharge. Multivariable logistic regression models controlled for age, gender, illness category, location of arrest, arrest duration, time of day, and time to first epinephrine dose. Secondary analysis separated patients on vasoactive infusion at the time of arrest from those without an infusion in place. Results Odds ratios (OR) calculated using 1–5 min/dose interval as reference. For the total cohort, adjusted OR for survival to hospital discharge for >5 to <8 min was 1.81 (95% CI 1.26–2.59), and 8 to <10 min 2.64 (95% CI 1.53–4.55). For patients not receiving vasoactive infusion, adjusted OR for survival to discharge for >5 to <8 min was 1.99 (95% CI 1.29-3.06) and 8 to <10 min 2.67 (95% CI 1.14–5.04). Conclusions Longer average dosing intervals than currently recommended for epinephrine administration during pediatric IHCA were associated with improved survival to hospital discharge.

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KW - Child

KW - Epinephrine

KW - Humans

KW - In-hospital cardiac arrest

KW - Registries

KW - Retrospective studies

KW - Vasoconstrictor agents

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