• Martha F Kienzle, Ryan W Morgan, Ron W Reeder, Tageldin Ahmed, Robert A Berg, Robert Bishop, Matthew Bochkoris, Joseph A Carcillo, Todd C Carpenter, Kellimarie K Cooper, J Wesley Diddle, Myke Federman, Richard Fernandez, Deborah Franzon, Aisha H Frazier, Stuart H Friess, Meg Frizzola, Kathryn Graham, Mark Hall, Christopher Horvat, Leanna L Huard, Tensing Maa, Arushi Manga, Patrick S McQuillen, Kathleen L Meert, Peter M Mourani, Vinay M Nadkarni, Maryam Y Naim, Murray M Pollack, Anil Sapru, Carleen Schneiter, Matthew P Sharron, Sarah Tabbutt, Shirley Viteri, Heather A Wolfe, Robert M Sutton, and Oxy-PICU Investigators of the Pediatric Critical Care Society Study Group.
• Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
• Crit. Care Med. 2024 Sep 1; 52 (9): 134413551344-1355.

ObjectivesData to support epinephrine dosing intervals during cardiopulmonary resuscitation (CPR) are conflicting. The objective of this study was to evaluate the association between epinephrine dosing intervals and outcomes. We hypothesized that dosing intervals less than 3 minutes would be associated with improved neurologic survival compared with greater than or equal to 3 minutes.DesignThis study is a secondary analysis of The ICU-RESUScitation Project (NCT028374497), a multicenter trial of a quality improvement bundle of physiology-directed CPR training and post-cardiac arrest debriefing.SettingEighteen PICUs and pediatric cardiac ICUs in the United States.PatientsSubjects were 18 years young or younger and 37 weeks old or older corrected gestational age who had an index cardiac arrest. Patients who received less than two doses of epinephrine, received extracorporeal CPR, or had dosing intervals greater than 8 minutes were excluded.InterventionsThe primary exposure was an epinephrine dosing interval of less than 3 vs. greater than or equal to 3 minutes.Measurements And Main ResultsThe primary outcome was survival to discharge with a favorable neurologic outcome defined as a Pediatric Cerebral Performance Category score of 1-2 or no change from baseline. Regression models evaluated the association between dosing intervals and: 1) survival outcomes and 2) CPR duration. Among 382 patients meeting inclusion and exclusion criteria, median age was 0.9 years (interquartile range 0.3-7.6 yr) and 45% were female. After adjustment for confounders, dosing intervals less than 3 minutes were not associated with survival with favorable neurologic outcome (adjusted relative risk [aRR], 1.10; 95% CI, 0.84-1.46; p = 0.48) but were associated with improved sustained return of spontaneous circulation (ROSC) (aRR, 1.21; 95% CI, 1.07-1.37; p < 0.01) and shorter CPR duration (adjusted effect estimate, -9.5 min; 95% CI, -14.4 to -4.84 min; p < 0.01).ConclusionsIn patients receiving at least two doses of epinephrine, dosing intervals less than 3 minutes were not associated with neurologic outcome but were associated with sustained ROSC and shorter CPR duration.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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