Abstract
Abstract 394: Epinephrine Administration Before Defibrillation in Children With an Initially Shockable In-Hospital Cardiac Arrest Rhythm
Circulation (New York, N.Y.), Vol.148(Suppl_1)
11/07/2023
DOI: 10.1161/circ.148.suppl_1.394
Abstract
Abstract only Background: Contrary to current guidelines, administration of epinephrine before first defibrillation for shockable in-hospital cardiac arrest (IHCA) is common in adults and associated with lower survival. Whether these findings are also present in pediatric IHCA remains unknown. Methods: We used 2000-2020 data from the Get With the Guidelines®—Resuscitation registry to identify children (<18 years) with index IHCA due to an initial shockable rhythm of ventricular fibrillation or pulseless ventricular tachycardia and at least 1 defibrillation attempt. Study outcomes were event survival, defined as return of spontaneous circulation for > 20 minutes, survival to hospital discharge and favorable neurologic survival. Inverse probability of treatment weighting (IPTW) using propensity scores was used to adjust for confounding . Results: Among 492 pediatric IHCA index events (median [IQR] age, 7 years [0.75 to 14 years]; 351 [71%] in the ICU), 142 (29%) children with an initial shockable rhythm received epinephrine before defibrillation. Subjects receiving epinephrine before defibrillation had longer times to defibrillation compared to those receiving defibrillation first (median [IQR]: 4 minutes [2 to 8] vs. 1 minute [0 to 2]). Rates of event survival (72.7% vs. 82.8%), survival to hospital discharge (36.4% vs. 47.9%), and favorable neurologic survival (18.9% vs. 33.1%) were lower in the epinephrine before defibrillation group, Table). However, in adjusted analyses using IPTW, epinephrine before defibrillation was not associated with survival outcomes (Table). Conclusions: Nearly one in three pediatric IHCA with initial shockable rhythm receives epinephrine before defibrillation in contrast with recommended guidelines. However, unlike adults with IHCA, we did not identify a clear association between epinephrine before defibrillation and survival.
Details
- Title: Subtitle
- Abstract 394: Epinephrine Administration Before Defibrillation in Children With an Initially Shockable In-Hospital Cardiac Arrest Rhythm
- Creators
- Morgan B Swanson - University of IowaJavier J Lasa - The University of Texas Southwestern Medical CenterPaul S Chan - Mid America Heart Institute, Kansas City, MORyan W Morgan - Children's Hospital of PhiladelphiaRobert M Sutton - Childrens Hosp of Philadephia, Philadelphia, PAAlexis A Topjian - Children's Hospital of PhiladelphiaDianne L Atkins - University of IowaSarah E Haskell - University of IowaTia T Raymond - Medical City Children's HospitalSaket Girotra - The University of Texas Southwestern Medical Center
- Resource Type
- Abstract
- Publication Details
- Circulation (New York, N.Y.), Vol.148(Suppl_1)
- DOI
- 10.1161/circ.148.suppl_1.394
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Language
- English
- Date published
- 11/07/2023
- Academic Unit
- Stead Family Department of Pediatrics; Cardiovascular Medicine; Internal Medicine; Critical Care
- Record Identifier
- 9984539530802771
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