• Mathias J Holmberg, Catherine E Ross, Tuyen Yankama, Joan S Roberts, Lars W Andersen, and American Heart Association’s Get With The Guidelines®-Resuscitation Investigators.
• Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. Electronic address: mathias.holmberg@clin.au.dk.
• Resuscitation. 2020 Apr 1; 149: 180-190.

AimTo determine whether the use of epinephrine in pediatric patients receiving cardiopulmonary resuscitation for bradycardia and poor perfusion was associated with improved clinical outcomes.MethodsUsing the Get With The Guidelines-Resuscitation registry, we included pediatric patients (≤18 years) who received in-hospital cardiopulmonary resuscitation for bradycardia with poor perfusion (non-pulseless event) between January 2000 and December 2018. Time-dependent propensity score matching was used to match patients receiving epinephrine within the first 10 min of resuscitation to patients at risk of receiving epinephrine within the same minute.ResultsIn the full cohort, 55% of patients were male and 39% were neonates. A higher number of patients receiving epinephrine required vasopressors and mechanical ventilation prior to the event compared to those not receiving epinephrine. A total of 3528 patients who received epinephrine were matched to 3528 patients at risk of receiving epinephrine based on the propensity score. Epinephrine was associated with decreased survival to hospital discharge (RR, 0.79 [95% CI, 0.74-0.85]; p < 0.001), return of spontaneous circulation (RR, 0.94 [95% CI, 0,91-0.96]; p < 0.001), 24-h survival (RR, 0.85 [95% CI, 0.81-0.90]; p < 0.001), and favorable neurological outcome (RR, 0.76 [95% CI, 0.68-0.84]; p < 0.001). Epinephrine was also associated with an increased risk of progression to pulselessness (RR, 1.17 [95% CI, 1.06-1.28]; p < 0.001).ConclusionIn children receiving cardiopulmonary resuscitation for bradycardia with poor perfusion, epinephrine was associated with worse outcomes, although the study does not eliminate the potential for confounding.Copyright © 2020 Elsevier B.V. All rights reserved.

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