Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest.

BACKGROUND: Current guidelines recommend epinephrine every 3-5min during cardiopulmonary resuscitation. For adults with in-hospital cardiac arrest (IHCA), longer dosing intervals are associated with improved survival to discharge. This study investigates whether longer epinephrine dosing intervals were associated with improved survival to discharge during pediatric IHCA. METHODS: Retrospective review of AHA Get With The Guidelines-Resuscitation registry identified 1630 pediatric IHCAs that met inclusion criteria. Average epinephrine dosing interval was defined by dividing duration of resuscitation after first dose of epinephrine by total doses. Average dosing intervals were categorized as 1-5min, >5 to <8min, and 8 to <10min/dose. Primary outcome was survival to hospital discharge. Multivariable logistic regression models controlled for age, gender, illness category, location of arrest, arrest duration, time of day, and time to first epinephrine dose. Secondary analysis separated patients on vasoactive infusion at the time of arrest from those without an infusion in place. RESULTS: Odds ratios (OR) calculated using 1-5min/dose interval as reference. For the total cohort, adjusted OR for survival to hospital discharge for >5 to <8min was 1.81 (95% CI 1.26-2.59), and 8 to <10min 2.64 (95% CI 1.53-4.55). For patients not receiving vasoactive infusion, adjusted OR for survival to discharge for >5 to <8min was 1.99 (95% CI 1.29-3.06) and 8 to <10min 2.67 (95% CI 1.14-5.04). CONCLUSIONS: Longer average dosing intervals than currently recommended for epinephrine administration during pediatric IHCA were associated with improved survival to hospital discharge.