The physiologic response to epinephrine and pediatric cardiopulmonary resuscitation outcomes.
Adrenaline
Blood pressure
Cardiac arrest
Cardiopulmonary resuscitation
Epinephrine
Pediatrics
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
13 03 2023
13 03 2023
Historique:
received:
28
12
2022
accepted:
08
03
2023
entrez:
14
3
2023
pubmed:
15
3
2023
medline:
16
3
2023
Statut:
epublish
Résumé
Epinephrine is provided during cardiopulmonary resuscitation (CPR) to increase systemic vascular resistance and generate higher diastolic blood pressure (DBP) to improve coronary perfusion and attain return of spontaneous circulation (ROSC). The DBP response to epinephrine during pediatric CPR and its association with outcomes have not been well described. Thus, the objective of this study was to measure the association between change in DBP after epinephrine administration during CPR and ROSC. This was a prospective multicenter study of children receiving ≥ 1 min of CPR with ≥ 1 dose of epinephrine and evaluable invasive arterial BP data in the 18 ICUs of the ICU-RESUS trial (NCT02837497). Blood pressure waveforms underwent compression-by-compression quantitative analysis. The mean DBP before first epinephrine dose was compared to mean DBP two minutes post-epinephrine. Patients with ≥ 5 mmHg increase in DBP were characterized as "responders." Among 147 patients meeting inclusion criteria, 66 (45%) were characterized as responders and 81 (55%) were non-responders. The mean increase in DBP with epinephrine was 4.4 [- 1.9, 11.5] mmHg (responders: 13.6 [7.5, 29.3] mmHg versus non-responders: - 1.5 [- 5.0, 1.5] mmHg; p < 0.001). After controlling for a priori selected covariates, epinephrine response was associated with ROSC (aRR 1.60 [1.21, 2.12]; p = 0.001). Sensitivity analyses identified similar associations between DBP response thresholds of ≥ 10, 15, and 20 mmHg and ROSC; DBP responses of ≥ 10 and ≥ 15 mmHg were associated with higher aRR of survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score of 1-3 or no worsening from baseline). The change in DBP following epinephrine administration during pediatric in-hospital CPR was associated with return of spontaneous circulation.
Sections du résumé
BACKGROUND
Epinephrine is provided during cardiopulmonary resuscitation (CPR) to increase systemic vascular resistance and generate higher diastolic blood pressure (DBP) to improve coronary perfusion and attain return of spontaneous circulation (ROSC). The DBP response to epinephrine during pediatric CPR and its association with outcomes have not been well described. Thus, the objective of this study was to measure the association between change in DBP after epinephrine administration during CPR and ROSC.
METHODS
This was a prospective multicenter study of children receiving ≥ 1 min of CPR with ≥ 1 dose of epinephrine and evaluable invasive arterial BP data in the 18 ICUs of the ICU-RESUS trial (NCT02837497). Blood pressure waveforms underwent compression-by-compression quantitative analysis. The mean DBP before first epinephrine dose was compared to mean DBP two minutes post-epinephrine. Patients with ≥ 5 mmHg increase in DBP were characterized as "responders."
RESULTS
Among 147 patients meeting inclusion criteria, 66 (45%) were characterized as responders and 81 (55%) were non-responders. The mean increase in DBP with epinephrine was 4.4 [- 1.9, 11.5] mmHg (responders: 13.6 [7.5, 29.3] mmHg versus non-responders: - 1.5 [- 5.0, 1.5] mmHg; p < 0.001). After controlling for a priori selected covariates, epinephrine response was associated with ROSC (aRR 1.60 [1.21, 2.12]; p = 0.001). Sensitivity analyses identified similar associations between DBP response thresholds of ≥ 10, 15, and 20 mmHg and ROSC; DBP responses of ≥ 10 and ≥ 15 mmHg were associated with higher aRR of survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score of 1-3 or no worsening from baseline).
CONCLUSIONS
The change in DBP following epinephrine administration during pediatric in-hospital CPR was associated with return of spontaneous circulation.
Identifiants
pubmed: 36915182
doi: 10.1186/s13054-023-04399-5
pii: 10.1186/s13054-023-04399-5
pmc: PMC10012560
doi:
Substances chimiques
Epinephrine
YKH834O4BH
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
105Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL131544
Pays : United States
Organisme : NICHD NIH HHS
ID : RL1 HD107777
Pays : United States
Investigateurs
Tageldin Ahmed
(T)
Michael J Bell
(MJ)
Robert Bishop
(R)
Matthew Bochkoris
(M)
Candice Burns
(C)
Joseph A Carcillo
(JA)
J Michael Dean
(JM)
J Wesley Diddle
(JW)
Myke Federman
(M)
Richard Fernandez
(R)
Ericka L Fink
(EL)
Stuart H Friess
(SH)
Mark Hall
(M)
David A Hehir
(DA)
Christopher M Horvat
(CM)
Leanna L Huard
(LL)
Tensing Maa
(T)
Arushi Manga
(A)
Patrick S McQuillen
(PS)
Peter M Mourani
(PM)
Daniel Notterman
(D)
Murray M Pollack
(MM)
Anil Sapru
(A)
Carleen Schneiter
(C)
Matthew P Sharron
(MP)
Neeraj Srivastava
(N)
Sarah Tabbutt
(S)
Shirley Viteri
(S)
David Wessel
(D)
Andrew R Yates
(AR)
Athena F Zuppa
(AF)
Informations de copyright
© 2023. The Author(s).
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