Journal article
Epinephrine Before Defibrillation in Children With Initially Shockable In-Hospital Cardiac Arrest
Critical care medicine, Vol.53(10), pp.e2005-e2015
10/2025
DOI: 10.1097/CCM.0000000000006804
PMCID: PMC13150723
PMID: 40736349
Abstract
Assess prevalence of epinephrine before or during the same minute as defibrillation and association with clinical outcomes in pediatric in-hospital cardiac arrest (IHCA).
Retrospective cohort study.
We used 2000-2020 data from the American Heart Association's Get With the Guidelines-Resuscitation Registry.
Children (< 18 yr) with index IHCA with an initial shockable rhythm of ventricular fibrillation or pulseless ventricular tachycardia and at least one defibrillation attempt.
None.
The primary exposure was epinephrine administration before or during the same minute as defibrillation. Study outcomes were survival to hospital discharge (primary outcome), return of spontaneous circulation (ROSC) for greater than or equal to 20 min, and survival with favorable neurologic outcome. Propensity-score matching was used for confounding adjustment. Among 492 pediatric IHCA index events with an initial shockable rhythm, median age was 7 years and 351 (71%) were in the ICU. Overall, 232 (47%) children received either epinephrine before defibrillation (29%) or during the same minute as defibrillation (18%). In unadjusted analyses, proportions of survival to hospital discharge (37.1% vs. 51.2%), ROSC (74.6% vs. 84.6%), and survival with favorable neurologic outcome (22.1% vs. 40.4%) were lower in the epinephrine before or during the same minute as defibrillation group. However, in adjusted analyses using propensity score matching with exact matching on time to defibrillation category, epinephrine before or during the same minute as defibrillation was not associated with hospital survival (odds ratio [OR] 0.84, 0.46-1.56), ROSC (OR 0.97, 0.48-1.96), or favorable neurologic outcome (OR 0.52, 0.27-1.00).
Contrary to current guidelines, nearly 50% of pediatric IHCA due to an initial shockable rhythm receive epinephrine before, or during the same minute, as first defibrillation. Although survival outcomes were numerically lower in epinephrine before defibrillation group, the association was not statistically significant.
Details
- Title: Subtitle
- Epinephrine Before Defibrillation in Children With Initially Shockable In-Hospital Cardiac Arrest
- Creators
- Morgan B Swanson - University of IowaJavier J Lasa - The University of Texas Southwestern Medical CenterPaul S Chan - Saint Luke's HospitalRyan W Morgan - University of PennsylvaniaRobert M Sutton - Children's Hospital of PhiladelphiaAlexis 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 CenterAmerican Heart Association’s Get With The Guidelines—Resuscitation Investigators
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.53(10), pp.e2005-e2015
- DOI
- 10.1097/CCM.0000000000006804
- PMID
- 40736349
- PMCID
- PMC13150723
- NLM abbreviation
- Crit Care Med
- ISSN
- 1530-0293
- eISSN
- 1530-0293
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Language
- English
- Electronic publication date
- 07/30/2025
- Date published
- 10/2025
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics; Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984927209002771
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