Epinephrine in Pediatric Out-of-Hospital Cardiac Arrest: Do Recommended Doses Improve Survival?

First Author(s)

• MR

  Morgan Recher, MD, PhD

  Dr
  University of Lille, France

  Disclosure information not submitted.

Co-Author(s)

• VB

  Valentine Baert, PhD

  Ms
  University of Lille, France

  Disclosure information not submitted.
• HH

  Hervé Hubert, PhD

  Mr
  University of Lille, France

  Disclosure information not submitted.
• SL

  Stephane Leteurtre, MD, PhD

  Pr
  University of Lille, France

  Disclosure information not submitted.

Title: EPINEPHRINE in PEDIATRIC OUT-OF-HOSPITAL CARDIAC ARREST: ARE RECOMMENDED DOSE IMPROVED SURVIVAL?
INTRODUCTION/HYPOTHESIS: Despite guidelines update in favor of the use of 0.01 mg/kg epinephrine in pediatric resuscitation, the impact of compliance with these recommendations on survival in young children has not been assessed. The aim of this study was to assess the impact of recommended versus non-recommended epinephrine dose on 30 days survival or at hospital discharge in prepubescent children with an out-hospital cardiac arrest (OHCA).

Methods: Multicentre retrospective comparative study between 2011 and 2021. Patients who receive recommended epinephrine dose were matched with those who received non-recommended epinephrine dose using propensity score-matching.

Results: The analysis included 755 prepubescent patients, 355 (47%) in the recommended epinephrine dose group and 400 (53%) in the non-recommended epinephrine dose group. Age was similar in both groups (median 1 year). In the non-recommended epinephrine dose group, the median per bolus epinephrine dose was higher than the recommended epinephrine dose group (0.04 vs. 0.01 mg/kg, p < 0.001). No difference was observed between both groups on return of spontaneous circulation, 0-day, 30-day survival or hospital discharge, and on good neurologic outcome. After matching, 288 pairs of patients were created. No difference was observed on return on spontaneous circulation or 0-day survival rates (OR=1.096 [95% CI: 0.753;1.596]; OR=1.216 [95% CI: 0.839;1.761]; respectively) and on 30-day or hospital discharge survival (n=12 in recommended epinephrine dose and 5 in non-recommended epinephrine dose groups) (OR=2.400 [95% CI: 0.846;6.812]). Only 2 patients in the recommended epinephrine dose group presented a good neurologic outcome (cerebral performance category 1-2).

Conclusions: More than 50% of patient did not receive recommended epinephrine dose. We did not observe association between recommended and non-recommended epinephrine doses on 30-day survival. Application of paediatric guidelines, impact of epinephrine injection or dose of epinephrine need futures studies.