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Aim <p>To compare post-epinephrine vasopressin administration versus epinephrine and time to return of spontaneous circulation (ROSC) during pediatric in-hospital cardiac arrest (IHCA), and explore vasopressin’s physiologic effects.</p> Methods <p>This single-center, retrospective cohort study (2017–2023) compared vasopressin patients who received ≥1 dose of preceding epinephrine and matched epinephrine-only patients based on age, illness category, and preceding epinephrine dosing. Time to ROSC was analyzed using Cox regression. Vasopressor response was defined as ≥5 mmHg increase in diastolic blood pressure (DBP).</p> Results <p>Forty-one matched pairs were analyzed. Median CPR duration was 36.5 [IQR 23, 48] minutes; median time to dose was 14.5 [10.8, 19] minutes. ROSC occurred in 10/41 (24%) vasopressin and 15/41 (36%) epinephrine patients (<i>p</i> = 0.34) with no difference in time to ROSC (aHR 0.73 [95% CI: 0.31–1.7]). Vasopressor response occurred in 4/12 (33%) vasopressin and 1/7 (14%) epinephrine patients (<i>p</i> = 0.60). Regression discontinuity analysis demonstrated a change in DBP of +2.3 mmHg after vasopressin (95% CI: −11.4, 16.0) and −5.67 mmHg after epinephrine (–15.13, 3.80).</p> Conclusion <p>No significant differences were found in time to ROSC or DBP increase between vasopressin and epinephrine given late during CPR. A subset of vasopressin responders suggests further research on intra-arrest DBP response to vasopressin is needed.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>The use of intra-arrest vasopressin is an understudied topic in pediatric cardiac arrest.</p> </ItemContent> <ItemContent> <p>This study presents a unique comparison of ongoing epinephrine to vasopressin administration, using dose matching to address the limitations of our current vasopressin use.</p> </ItemContent> <ItemContent> <p>We present a novel analysis of physiologic response to vasopressin using the change in diastolic blood pressure.</p> </ItemContent> </UnorderedList></p>

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Comparison of vasopressin to epinephrine during pediatric in-hospital cardiac arrest: survival and physiologic responsiveness

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月4日

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  • Morgann Loaec,
  • Garrett Keim,
  • Kathryn Graham,
  • Martha F. Kienzle,
  • Amanda O’Halloran,
  • Lindsay N. Shepard,
  • Sanjiv Mehta,
  • Samridhi Sawhney,
  • Marion Donoghue,
  • Kellimarie Cooper,
  • Todd J. Kilbaugh,
  • Vinay Nadkarni,
  • Alexis A. Topjian,
  • Robert A. Berg,
  • Robert M. Sutton,
  • Ryan W. Morgan

摘要

Aim

To compare post-epinephrine vasopressin administration versus epinephrine and time to return of spontaneous circulation (ROSC) during pediatric in-hospital cardiac arrest (IHCA), and explore vasopressin’s physiologic effects.

Methods

This single-center, retrospective cohort study (2017–2023) compared vasopressin patients who received ≥1 dose of preceding epinephrine and matched epinephrine-only patients based on age, illness category, and preceding epinephrine dosing. Time to ROSC was analyzed using Cox regression. Vasopressor response was defined as ≥5 mmHg increase in diastolic blood pressure (DBP).

Results

Forty-one matched pairs were analyzed. Median CPR duration was 36.5 [IQR 23, 48] minutes; median time to dose was 14.5 [10.8, 19] minutes. ROSC occurred in 10/41 (24%) vasopressin and 15/41 (36%) epinephrine patients (p = 0.34) with no difference in time to ROSC (aHR 0.73 [95% CI: 0.31–1.7]). Vasopressor response occurred in 4/12 (33%) vasopressin and 1/7 (14%) epinephrine patients (p = 0.60). Regression discontinuity analysis demonstrated a change in DBP of +2.3 mmHg after vasopressin (95% CI: −11.4, 16.0) and −5.67 mmHg after epinephrine (–15.13, 3.80).

Conclusion

No significant differences were found in time to ROSC or DBP increase between vasopressin and epinephrine given late during CPR. A subset of vasopressin responders suggests further research on intra-arrest DBP response to vasopressin is needed.

Impact

The use of intra-arrest vasopressin is an understudied topic in pediatric cardiac arrest.

This study presents a unique comparison of ongoing epinephrine to vasopressin administration, using dose matching to address the limitations of our current vasopressin use.

We present a novel analysis of physiologic response to vasopressin using the change in diastolic blood pressure.