The physiologic response to epinephrine and pediatric cardiopulmonary resuscitation outcomes
Ryan W. Morgan,
Robert A. Berg,
Ron W. Reeder,
Todd C. Carpenter,
Deborah Franzon,
Aisha H. Frazier,
Kathryn Graham,
Kathleen L. Meert,
Vinay M. Nadkarni,
Maryam Y. Naim,
Bradley Tilford,
Heather A. Wolfe,
Andrew R. Yates,
Robert M. Sutton,
the ICU-RESUS and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups
Affiliations
Ryan W. Morgan
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania
Robert A. Berg
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania
Ron W. Reeder
Department of Pediatrics, University of Utah
Todd C. Carpenter
Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado
Deborah Franzon
Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco
Aisha H. Frazier
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children
Kathryn Graham
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania
Kathleen L. Meert
Department of Pediatrics, Children’s Hospital of Michigan, Central Michigan University
Vinay M. Nadkarni
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania
Maryam Y. Naim
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania
Bradley Tilford
Department of Pediatrics, Children’s Hospital of Michigan, Central Michigan University
Heather A. Wolfe
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania
Andrew R. Yates
Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University
Robert M. Sutton
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania
the ICU-RESUS and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups
Abstract Background Epinephrine is provided during cardiopulmonary resuscitation (CPR) to increase systemic vascular resistance and generate higher diastolic blood pressure (DBP) to improve coronary perfusion and attain return of spontaneous circulation (ROSC). The DBP response to epinephrine during pediatric CPR and its association with outcomes have not been well described. Thus, the objective of this study was to measure the association between change in DBP after epinephrine administration during CPR and ROSC. Methods This was a prospective multicenter study of children receiving ≥ 1 min of CPR with ≥ 1 dose of epinephrine and evaluable invasive arterial BP data in the 18 ICUs of the ICU-RESUS trial (NCT02837497). Blood pressure waveforms underwent compression-by-compression quantitative analysis. The mean DBP before first epinephrine dose was compared to mean DBP two minutes post-epinephrine. Patients with ≥ 5 mmHg increase in DBP were characterized as “responders.” Results Among 147 patients meeting inclusion criteria, 66 (45%) were characterized as responders and 81 (55%) were non-responders. The mean increase in DBP with epinephrine was 4.4 [− 1.9, 11.5] mmHg (responders: 13.6 [7.5, 29.3] mmHg versus non-responders: − 1.5 [− 5.0, 1.5] mmHg; p < 0.001). After controlling for a priori selected covariates, epinephrine response was associated with ROSC (aRR 1.60 [1.21, 2.12]; p = 0.001). Sensitivity analyses identified similar associations between DBP response thresholds of ≥ 10, 15, and 20 mmHg and ROSC; DBP responses of ≥ 10 and ≥ 15 mmHg were associated with higher aRR of survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score of 1–3 or no worsening from baseline). Conclusions The change in DBP following epinephrine administration during pediatric in-hospital CPR was associated with return of spontaneous circulation.
