Early bolus epinephrine administration during pediatric cardiopulmonary resuscitation for bradycardia with poor perfusion: an ICU-resuscitation study

O'Halloran, AJ; Reeder, RW; Berg, RA; Ahmed, T; Bell, MJ; Bishop, R; Bochkoris, M; Burns, C; Carcillo, JA; Carpenter, TC; Dean, JM; Diddle, JW; Federman, M; Fernandez, R; Fink, EL; Franzon, D; Frazier, AH; Friess, SH; Graham, K; Hall, M; Hehir, DA; Horvat, CM; Huard, LL; Kienzle, MF; Kilbaugh, TJ; Maa, T; Manga, A; McQuillen, PS; Meert, KL; Mourani, PM; Nadkarni, VM; Naim, MY; Notterman, D; Pollack, MM; Sapru, A; Schneiter, C; Sharron, MP; Srivastava, N; Tilford, B; Topjian, AA; Viteri, S; Wessel, D; Wolfe, HA; Yates, AR; Zuppa, AF; Sutton, RM; Morgan, RW

doi:10.1186/s13054-024-05018-7

Cardiac arrest & resuscitation

Early bolus epinephrine administration during pediatric cardiopulmonary resuscitation for bradycardia with poor perfusion: an ICU-resuscitation study

Crit CarePublished 16 Jul 2024Secondary analysis of the ICU-RESUScitation (ICU-RESUS) randomised trial

Primary result · Survival to dischargeResultARR for survival to discharge 0.97 95% CI 0.82–1.14

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Authors' conclusion

In this cohort of pediatric CPR events with an initial rhythm of bradycardia with poor perfusion, we failed to identify an association between early bolus epinephrine and outcomes when controlling for illness severity.

Study context

Population: Children (< 19 years) receiving cardiopulmonary resuscitation (CPR) ≥ 2 min for initial rhythm of bradycardia with poor perfusion in 18 US ICUs, October 2016-March 2021
Participants: 452 eligible subjects

Comparison: Early epinephrine vs no early epinephrine
Early epinephrinen = 322
Primary endpoint: Survival to discharge

Methodological detailsprespecified, multicentre, cluster randomised

Prespecified
Multicentre
Cluster randomised

Primary result

As reported in the abstract

ARR for survival to discharge

0.97

95% CI 0.82–1.14

Early epinephrine vs No early epinephrine

aRR for survival to discharge 0.97 (95% CI 0.82–1.14)

Further findings

Outcome	Values		aRR for survival with favorable neurologic outcome (95% CI)
Survival with favorable neurologic outcome		0.512	0.99 (0.82–1.18)
		0.512ARR for survival with favorable neurologic outcome (log scale)

Outcome	Values	P value
Pulselessness during first 10 min of CPR (patients with invasive BP waveforms)	Invasive BP waveforms 63% · by 2 min 86 (46%) · by 3 min 100 (54%)
Sustained ROSC by pulselessness statusAcross the three groups	Bradycardia with poor perfusion 84% · Progressing to pulselessness 43% · Pulselessness then return to bradycardia with poor perfusion 62%	P < 0.001

Pulselessness during first 10 min of CPR (patients with invasive BP waveforms): n = 186 with invasive BP waveforms

Reference

Authors: O'Halloran AJ, Reeder RW, Berg RA, Ahmed T, Bell MJ, Bishop R, et al.
All 47 authors
O'Halloran AJ, Reeder RW, Berg RA, Ahmed T, Bell MJ, Bishop R, Bochkoris M, Burns C, Carcillo JA, Carpenter TC, Dean JM, Diddle JW, Federman M, Fernandez R, Fink EL, Franzon D, Frazier AH, Friess SH, Graham K, Hall M, Hehir DA, Horvat CM, Huard LL, Kienzle MF, Kilbaugh TJ, Maa T, Manga A, McQuillen PS, Meert KL, Mourani PM, Nadkarni VM, Naim MY, Notterman D, Pollack MM, Sapru A, Schneiter C, Sharron MP, Srivastava N, Tilford B, Topjian AA, Viteri S, Wessel D, Wolfe HA, Yates AR, Zuppa AF, Sutton RM, Morgan RW
Journal: Critical Care
Published: 16 Jul 2024
DOI: 10.1186/s13054-024-05018-7
PubMed: 39010134

Topic: Cardiac arrest & resuscitation
Also indexed: Pediatric anesthesia & critical care

Comparison

Early epinephrine (first 2 min of CPR) vs no early epinephrine

Key notes

Poisson multivariable regression controlling for pre-arrest characteristics

Original publication

Early bolus epinephrine administration during pediatric cardiopulmonary resuscitation for bradycardia with poor perfusion: an ICU-resuscitation study. Crit Care. Published 16 July 2024. doi:10.1186/s13054-024-05018-7

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