Prompt Adrenaline Use Reduces Pediatric Cardiac Arrest Mortality

Timely use of epinephrine is associated with increased survival among hospitalized children suffering a non-shockable cardiac rhythm arrest, according to a new study.

Researchers at Beth Israel Deaconess Medical Center (BIDMC; Boston, MA, USA), Aarhus University Hospital (Denmark), and other institutions performed an analysis of data from the Get With the Guidelines—Resuscitation registry (GWTG-R). Participants included 1,558 US pediatric patients with an in-hospital cardiac arrest and an initial non-shockable rhythm that received at least one dose of epinephrine. The primary outcome was survival to hospital discharge; secondary outcomes included return of spontaneous circulation (ROSC), survival at 24 hours, and neurological outcome.

The results showed that children who did not receive epinephrine within five minutes of the event had a lower likelihood of survival than children who did (21% versus 33.1%). Delays in epinephrine administration were also associated with worse outcomes on secondary measures, including ROSC, survival at 24 hours, and resultant neurological impairment. Analysis of the data found that each minute of delay in epinephrine administration cut survival rates by a further 5%. The study was published in the August 25, 2015, issue of the Journal of the American Medical Association (JAMA).

“These associations remained when accounting for multiple predetermined potentially confounding patient, event, and hospital characteristics and in multiple difference sensitivity analyses,” concluded lead author Lars W. Anderson, MD, and colleagues. “Although the observational design precludes ascertainment of causality, the strong association with outcomes suggests that early epinephrine may be beneficial in pediatric cardiac arrest.”

Epinephrine is the primary drug administered to reverse cardiac arrest as it increases arterial blood pressure and coronary perfusion via alpha-1-adrenoceptor agonist effects. The American Heart Association (AHA; Dallas, TX, USA) 2010 pediatric advanced life support (PALS) guidelines recommend that pediatric patients with non-shockable rhythm arrest receive a 0.01 mg/kg dose of epinephrine (with a maximum of one mg) as soon as vascular or intraosseous access is obtained, followed by repeat administration every 3–5 minutes.

Related Links:
Beth Israel Deaconess Medical Center
Aarhus University Hospital
American Heart Association