High dose of epinephrine does not improve survival of children with out-of-hospital cardiac arrest: Results from the French National Cardiac Arrest Registry

Abstract

ObjectivesThe pediatric resuscitation guidelines recommend the use of 0. 01 mg kg−1 epinephrine during a cardiac arrest; an epinephrine dose higher than that is not recommended. The first aim of this study was to determine the administration rate of high epinephrine dose during pediatric out-of-hospital cardiac arrest. The second aim was to compare the survival status in patients who received high or standard doses of epinephrine.MethodsThis was a multicenter comparative post-hoc study conducted between January 2011 and July 2021 based on the French National Cardiac Arrest Registry data. All prepubescent (boys < 12 years old, girls < 10 years old) victims of an out-of-hospital cardiac arrest were included. To compare survival status and control bias, patients who received a high epinephrine dose were matched with those who received a standard epinephrine dose using propensity score matching.ResultsThe analysis included 755 patients; 400 (53%) received a high dose and 355 (47%) received a standard dose of epinephrine. The median dose (mg kg−1) per bolus was higher in the high-dose group than that in the standard dose group (0.04 vs. 0.01 mg kg−1, P < 0.001). Before matching, there was no between-group difference in the 30-day survival rate or survival status at hospital discharge. Matching yielded 288 pairs; there was no between-group difference in the 30-day survival rate or survival at hospital discharge (High dose, n = 5; standard dose, n = 12; Odds ratios: 2.40, 95% confidence interval: 0.85–6.81). Only 2 patients in the standard dose group had a good neurological outcome.ConclusionMore than 50% of the patients did not receive the recommended epinephrine dose during resuscitation. There was no association between patients receiving a high dose or standard dose of epinephrine with the 30-day survival or survival status at hospital discharge. Collaboration across multiple cardiac arrest registries is needed to study the application of pediatric guidelines.

Out-of-hospital cardiac arrest in children: An epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation

“…However, as current registry variables do not support the proposed format, such a chart was not applied in our study. (2) Due to the retrospective nature of this study, it was not possible to assess causation for different interventions like airway management [2,27] or dosage of adrenaline [13].…”

“…It is crucial to differentiate between respiratory and cardiopulmonary arrest; however, this is not always possible, especially in retrospective cohort studies. While there is an increase in the analyses of speci c treatment strategies [2,12,13], recent large epidemiological studies across a whole nation or a continent are lacking. These can help EMS systems to tailor their pediatric advanced life support (PALS) training and provide the best possible care.…”

Out-of-hospital cardiac arrest in children: an epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation

“…It is crucial to differentiate between respiratory and cardiopulmonary arrest; however, this is not always possible, especially in retrospective cohort studies. While there is an increase in the analyses of specific treatment strategies [2,12,13], recent large epidemiological studies across a whole nation or a continent are lacking. These can help EMS systems to tailor their paediatric advanced life support (PALS) training and provide the best possible care.…”

Epinephrine Dosing Use During Extracorporeal Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort*

“…Nevertheless, high vasopressor delivery can be detrimental to mechanical circulatory support such as ECMO due to the consequent increased afterload, which may impair systemic blood flow. Routine use of epinephrine during CPR may also lead to detrimental side effects such as increased myocardial work, inadequate regional blood flow due to increased microvascular vasoconstriction, reperfusion injury, and lactic acidosis (12)(13)(14)(15)(16)(17)(18)(19)(20). Taken together, these possible effects could lead to a need of further vasoactive use, increased mechanical support, and by progression an overall increased inflammatory response that may promote prolonged vasoconstriction.…”