Shorter epinephrine dosing intervals and one-year survival after in-hospital pediatric cardiopulmonary resuscitation

Abstract

Objective: To evaluate the association between the interval doses of epinephrine and one-year survival and one-year neurological prognosis after pediatric in-hospital cardiac arrest (IHCA). Methods: This observational retrospective cohort study included pediatric patients (0–18 years) who experienced IHCA and received at least two doses of epinephrine from January 2015 to December 2022. Data were collected following the Utstein style. The mean interval between epinephrine doses was categorized as 〈 3, 3–5, or > 5 min. Primary outcome was one-year survival; secondary outcomes were survival to hospital discharge and one-year neurological prognosis, assessed by the Pediatric Cerebral Performance Category. Results: 194 patients were eligible. In the univariate adjusted analysis, patients who received epinephrine at intervals shorter than 3 min had a 2.3-fold increased chance of one-year survival (OR 2.3; 95 % CI 1.0–5.5; p = 0.042), although this association was not sustained in the multivariable regression. Longer intervals between epinephrine doses (OR: 0.71; 95 % CI 0.52–0.71; p = 0.03), continuous vasoactive drugs infusion prearrest (OR 0.1; 95 % CI 0.1–0.4; p < 0.001), longer resuscitation duration (OR 0.8; 95 % CI 0.7–0.9; p = 0.028), epinephrine doses (OR 0.68; 95 % CI 0.56–0.81; p < 0.001) were associated with reduced one-year survival. Neurological deterioration was observed in 6 (16.6 %) of the 36 patients after one year (p = 0.001). No association was found between epinephrine dosing intervals (OR 0.72; 95 % CI 0.16–3.14; p = 0.65) and neurological outcomes. Conclusion: Epinephrine dosing interval was not independently associated with one-year survival after adjusted analyses. These findings underscore the complexity of pediatric resuscitation and support further multicenter prospective studies.