• Catherine E Ross, Ari Moskowitz, Anne V Grossestreuer, Mathias J Holmberg, Lars W Andersen, Tuyen T Yankama, Robert A Berg, Amanda O'Halloran, Monica E Kleinman, Michael W Donnino, and American Heart Association’s Get With The Guidelines – Resuscitation Investigators.
• Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, 333 Longwood Avenue, Boston, MA, 02115, USA; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 359 Brookline Avenue, Boston, MA, 02115, USA. Electronic address: Catherine.Ross@childrens.harvard.edu.
• Resuscitation. 2021 Jan 1; 158: 243-252.

AimsTo describe trends in pediatric in-hospital cardiac arrest drug administration and to assess temporal associations of the Pediatric Advanced Life Support (PALS) guideline changes with drug usage.MethodsPediatric patients <18 years old with in-hospital cardiac arrest recorded in the American Heart Association Get With The Guidelines-Resuscitation database between 2002 and 2018 were included. The annual adjusted odds of receiving each intra-arrest medication was determined. The association between changes in the PALS Guidelines and medication use over time was assessed interrupted time series analyses.ResultsA total of 6107 patients were analyzed. The adjusted odds of receiving lidocaine (0.33; 95% CI, 0.18, 0.61; p < 0.001), atropine (0.19; 95% CI 0.12, 0.30; p < 0.001) and bicarbonate (0.54; 95% CI 0.35, 0.86; p = 0.009) were lower in 2018 compared to 2002. For lidocaine, there were no significant changes in the step (-2.1%; 95% CI, -5.9%, 1.6%; p = 0.27) after the 2010 or 2015 (Step: -1.5%; 95% CI, -8.0%, 5.0; p = 0.65) guideline releases. There were no significant changes in the step for bicarbonate (-2.3%; 95% CI, -7.6%, 3.0%; p = 0.39) after the 2010 updates. For atropine, there was a downward step change after the 2010 guideline release (-5.9%; 95% CI, -10.5%, -1.3%; p = 0.01).ConclusionsChanges to the PALS guidelines for lidocaine and bicarbonate were not temporally associated with acute changes in the use of these medications; however, better alignment with these updates was observed over time. A minor update to the language surrounding atropine in the PALS text was associated with a modest acute change in the observed use of atropine. Future studies exploring other factors that influence prescribers in pediatric IHCA are needed.Copyright © 2020 Elsevier B.V. All rights reserved.

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