ScholarLink (思领科)
错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Early bolus epinephrine administration during pediatric cardiopulmonary resuscitation for bradycardia with poor perfusion: an ICU-resuscitation study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2024年7月16日

查看全文
  • Amanda J. O’Halloran,
  • Ron W. Reeder,
  • Robert A. Berg,
  • Tageldin Ahmed,
  • Michael J. Bell,
  • Robert Bishop,
  • Matthew Bochkoris,
  • Candice Burns,
  • Joseph A. Carcillo,
  • Todd C. Carpenter,
  • J. Michael Dean,
  • J. Wesley Diddle,
  • Myke Federman,
  • Richard Fernandez,
  • Ericka L. Fink,
  • Deborah Franzon,
  • Aisha H. Frazier,
  • Stuart H. Friess,
  • Kathryn Graham,
  • Mark Hall,
  • David A. Hehir,
  • Christopher M. Horvat,
  • Leanna L. Huard,
  • Martha F. Kienzle,
  • Todd J. Kilbaugh,
  • Tensing Maa,
  • Arushi Manga,
  • Patrick S. McQuillen,
  • Kathleen L. Meert,
  • Peter M. Mourani,
  • Vinay M. Nadkarni,
  • Maryam Y. Naim,
  • Daniel Notterman,
  • Murray M. Pollack,
  • Anil Sapru,
  • Carleen Schneiter,
  • Matthew P. Sharron,
  • Neeraj Srivastava,
  • Bradley Tilford,
  • Alexis A. Topjian,
  • Shirley Viteri,
  • David Wessel,
  • Heather A. Wolfe,
  • Andrew R. Yates,
  • Athena F. Zuppa,
  • Robert M. Sutton,
  • Ryan W. Morgan

摘要

Background

Half of pediatric in-hospital cardiopulmonary resuscitation (CPR) events have an initial rhythm of non-pulseless bradycardia with poor perfusion. Our study objectives were to leverage granular data from the ICU-RESUScitation (ICU-RESUS) trial to: (1) determine the association of early epinephrine administration with survival outcomes in children receiving CPR for bradycardia with poor perfusion; and (2) describe the incidence and time course of the development of pulselessness.

Methods

Prespecified secondary analysis of ICU-RESUS, a multicenter cluster randomized trial of children (< 19 years) receiving CPR in 18 intensive care units in the United States. Index events (October 2016–March 2021) lasting ≥ 2 min with a documented initial rhythm of bradycardia with poor perfusion were included. Associations between early epinephrine (first 2 min of CPR) and outcomes were evaluated with Poisson multivariable regression controlling for a priori pre-arrest characteristics. Among patients with arterial lines, intra-arrest blood pressure waveforms were reviewed to determine presence of a pulse during CPR interruptions. The temporal nature of progression to pulselessness was described and outcomes were compared between patients according to subsequent pulselessness status.

Results

Of 452 eligible subjects, 322 (71%) received early epinephrine. The early epinephrine group had higher pre-arrest severity of illness and vasoactive-inotrope scores. Early epinephrine was not associated with survival to discharge (aRR 0.97, 95%CI 0.82, 1.14) or survival with favorable neurologic outcome (aRR 0.99, 95%CI 0.82, 1.18). Among 186 patients with invasive blood pressure waveforms, 118 (63%) had at least 1 period of pulselessness during the first 10 min of CPR; 86 (46%) by 2 min and 100 (54%) by 3 min. Sustained return of spontaneous circulation was highest after bradycardia with poor perfusion (84%) compared to bradycardia with poor perfusion progressing to pulselessness (43%) and bradycardia with poor perfusion progressing to pulselessness followed by return to bradycardia with poor perfusion (62%) (p < 0.001).

Conclusions

In this cohort of pediatric CPR events with an initial rhythm of bradycardia with poor perfusion, we failed to identify an association between early bolus epinephrine and outcomes when controlling for illness severity. Most children receiving CPR for bradycardia with poor perfusion developed subsequent pulselessness, 46% within 2 min of CPR onset.