Abstract
Aim
To quantify the physiologic effects of pre-arrest bolus dilute epinephrine in the
pediatric intensive care unit.
Methods
Patients <18 years old and ≥37 weeks gestation who received an intravenous bolus of
dilute epinephrine (10 mcg/mL) in the pediatric intensive care units at our institution
from January 2011 to March 2017 were retrospectively identified. Patients were excluded
if doses exceeded 20 mcg/kg, or under the following circumstances: orders limiting
resuscitation, extracorporeal membrane oxygenation, active chest compressions, simultaneous
administration of other blood pressure-altering interventions or documented normotension
prior to epinephrine. The primary outcome was change in systolic blood pressure within
5 min of epinephrine. Patients were categorized as non-responders if the change in
systolic blood pressure was ≤10 mmHg.
Results
One hundred forty-four patients were analyzed. The median index dose was 0.7 mcg/kg
(IQR, 0.3–2.0), and the mean increase in systolic blood pressure was 31 mmHg (95%
CI, 25–36; P < 0.001). Thirty-nine (27%) patients were classified as non-responders.
Compared to responders, non-responders had higher rates of cardiac arrest or extracorporeal
membrane oxygenation within 6 h (26% vs 10%; relative risk, 2.69; 95% CI, 1.21–5.97;
P = 0.03), and had higher in-hospital mortality (51% vs 21%; relative risk, 2.45;
95% CI, 1.51–3.96; P < 0.001).
Conclusions
In the majority of pre-arrest pediatric patients, bolus dilute epinephrine resulted
in an increase in systolic blood pressure, and lack of blood pressure response was
associated with poor outcomes. Optimal dosing of dilute epinephrine remains unclear.
Abbreviations:
IHCA (in-hospital cardiac arrest), ICU (intensive care unit), BDE (bolus dilute epinephrine), ECMO (extracorporeal membrane oxygenation), BCH (Boston Children’s Hospital), SBP (systolic blood pressure), MAP (mean arterial pressure), DBP (diastolic blood pressure), HR (heart rate)Keywords
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Article info
Publication history
Published online: March 08, 2018
Accepted:
March 7,
2018
Received in revised form:
February 16,
2018
Received:
January 2,
2018
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.03.011.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
