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      Early Epinephrine Improves the Stabilization of Initial Post-resuscitation Hemodynamics in Children With Non-shockable Out-of-Hospital Cardiac Arrest

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          Abstract

          Background: In children with non-shockable out-of-hospital cardiac arrest, early epinephrine (EE) might help to establish the return of spontaneous circulation (ROSC) and be associated with survival. In the present study, we aimed to analyze the effects of EE on outcomes and post-resuscitation hemodynamics in children with non-shockable OHCA.

          Methods: This was a retrospective analysis of data from 216 children (<19 years) who had suffered non-traumatic and non-shockable OHCA and received epinephrine for resuscitation (Jan 1, 2006–Dec 31, 2014). Demographics, pre-/in-hospital information, and the time to the first dose of epinephrine were recorded. Early post-resuscitation hemodynamics (the first hour after sustained ROSC), survival and good neurological outcomes (Pediatric Cerebral Performance Category Scales 1 or 2) were analyzed by the time to epinephrine—classified as early (EE): <15 min, intermediate (IE): 15–30 min, or late (LE): >30 min.

          Results: Twenty-eight (13.0%) children survived to discharge, but only 17 (7.9%) had good neurological outcomes. In all, 41 (18.9%) children received EE; in comparison to IE and LE, this was significantly associated with tachycardia (73.9%) in the post-resuscitation period ( p < 0.05). Tachycardia (OR: 7.41, 95% CI: 1.96–29.31) and hypertension (OR: 6.03, 95% CI: 1.85–13.77) were significantly associated with EE after adjusting for confounding factors. EE was also significantly associated with better overall outcomes than ME and LE (any ROSC, sustained ROSC, survival to the intensive care unit, admission, survival to discharge and good neurological outcomes, all p < 0.05).

          Conclusions: EE helped to establish ROSC but was also associated with more tachycardia and hypertension in the early post-resuscitation period. In children with non-traumatic and non-shockable OHCA, EE was associated with a higher survival rate and better neurological outcomes than were ME and LE.

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          A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest

          Kyee Han, Nigel Stallard, Stavros Petrou … (2018)
          Concern about the use of epinephrine as a treatment for out-of-hospital cardiac arrest led the International Liaison Committee on Resuscitation to call for a placebo-controlled trial to determine whether the use of epinephrine is safe and effective in such patients.
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            Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa).

            Ian Jacobs, Vinay Nadkarni, Jan Bahr … (2004)
            Outcome following cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002 a task force of ILCOR met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (i.e., essential and desirable) data elements recommended by previous Utstein consensus conference. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, EMS system, and community.
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              Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

              Allan R de Caen, Marc D Berg, Leon Chameides … (2015)
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Pediatr
                Journal ID (iso-abbrev): Front Pediatr
                Journal ID (publisher-id): Front. Pediatr.
                Title: Frontiers in Pediatrics
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2296-2360
                Publication date (Electronic): 06 June 2019
                Publication date Collection: 2019
                Volume: 7
                Electronic Location Identifier: 220
                Affiliations
                [1] 1Department of Emergency Medicine, Changhua Christian Hospital , Changhua City, Taiwan
                [2] 2School of Medicine, Chung Shan Medical University , Taichung City, Taiwan
                [3] 3School of Medicine, Kaohsiung Medical University , Kaohsiung City, Taiwan
                [4] 4Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine , Kaohsiung City, Taiwan
                [5] 5Department of Leisure and Sports Management, Cheng Shiu University , Kaohsiung City, Taiwan
                [6] 6Department of Biological Science and Technology, National Chiao Tung University , Hsinchu, Taiwan
                [7] 7Department of Nursing, Dayeh University , Changhua City, Taiwan
                [8] 8Department of Nursing, Changhua Christian Hospital , Changhua City, Taiwan
                Author notes

                Edited by: Aristomenis K. Exadaktylos, Bern University Hospital, Switzerland

                Reviewed by: Vijay Srinivasan, Children's Hospital of Philadelphia, United States; Robert Kelly, Children's Hospital of Orange County, United States

                *Correspondence: Hsi-Wen Huang 68956@ 123456cch.org.tw

                This article was submitted to Pediatric Critical Care, a section of the journal Frontiers in Pediatrics

                Article
                DOI: 10.3389/fped.2019.00220
                PMC ID: 6563720
                PubMed ID: 31245334
                SO-VID: f2213d95-ffec-497d-8fb7-53aaaf6dd607
                Copyright © Copyright © 2019 Lin, Li, Huang, Lee, Chen, Yang, Chou, Chang, Huang, Hsu and Chen.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 27 February 2019
                Date accepted : 15 May 2019
                Page count
                Figures: 1, Tables: 4, Equations: 0, References: 48, Pages: 9, Words: 5725
                Categories
                Subject: Pediatrics
                Subject: Original Research

                Keywords: epinephrine,children,ohca,survival,non-shockable,time,early,outcome
                Data availability:
                Keywords: epinephrine, children, ohca, survival, non-shockable, time, early, outcome

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