Epinephrine Dosing Intervals Are Associated With Pediatric In-Hospital Cardiac Arrest Outcomes: A Multicenter Study*
Why is this work in the frame?
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
No Canadian affiliation. An affiliation-only frame — the usual design — would never have seen this work. It is one of the works that make the case for inverting the frame.
The three-model screen
all 1,000 screened works →All three models called this out of scope.
Secondary analysis of trial data on epinephrine dosing intervals and pediatric cardiac arrest outcomes; a clinical question.
It evaluates epinephrine dosing intervals and cardiac-arrest outcomes, not research practice.
Pediatric cardiac-arrest outcomes vs epinephrine dosing intervals; clinical resuscitation research.
Abstract
OBJECTIVES: Data to support epinephrine dosing intervals during cardiopulmonary resuscitation (CPR) are conflicting. The objective of this study was to evaluate the association between epinephrine dosing intervals and outcomes. We hypothesized that dosing intervals less than 3 minutes would be associated with improved neurologic survival compared with greater than or equal to 3 minutes. DESIGN: This study is a secondary analysis of The ICU-RESUScitation Project (NCT028374497), a multicenter trial of a quality improvement bundle of physiology-directed CPR training and post-cardiac arrest debriefing. SETTING: Eighteen PICUs and pediatric cardiac ICUs in the United States. PATIENTS: Subjects were 18 years young or younger and 37 weeks old or older corrected gestational age who had an index cardiac arrest. Patients who received less than two doses of epinephrine, received extracorporeal CPR, or had dosing intervals greater than 8 minutes were excluded. INTERVENTIONS: The primary exposure was an epinephrine dosing interval of less than 3 vs. greater than or equal to 3 minutes. MEASUREMENTS AND MAIN RESULTS: The primary outcome was survival to discharge with a favorable neurologic outcome defined as a Pediatric Cerebral Performance Category score of 1-2 or no change from baseline. Regression models evaluated the association between dosing intervals and: 1) survival outcomes and 2) CPR duration. Among 382 patients meeting inclusion and exclusion criteria, median age was 0.9 years (interquartile range 0.3-7.6 yr) and 45% were female. After adjustment for confounders, dosing intervals less than 3 minutes were not associated with survival with favorable neurologic outcome (adjusted relative risk [aRR], 1.10; 95% CI, 0.84-1.46; p = 0.48) but were associated with improved sustained return of spontaneous circulation (ROSC) (aRR, 1.21; 95% CI, 1.07-1.37; p < 0.01) and shorter CPR duration (adjusted effect estimate, -9.5 min; 95% CI, -14.4 to -4.84 min; p < 0.01). CONCLUSIONS: In patients receiving at least two doses of epinephrine, dosing intervals less than 3 minutes were not associated with neurologic outcome but were associated with sustained ROSC and shorter CPR duration.
Stored with the screening record, where it is evidence for the labels above.
The record
- Venue
- Critical Care Medicine
- Topic
- Cardiac Arrest and Resuscitation
- Field
- Medicine
- Canadian institutions
- —
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentU.S. Department of DefenseAgency for Healthcare Research and QualityNational Institutes of HealthChildren's Hospital of PhiladelphiaSwedish Orphan BiovitrumLaerdal Foundation for Acute MedicineNational Institute of Child Health and Human DevelopmentZOLL Medical CorporationNational Heart, Lung, and Blood InstituteMallinckrodt PharmaceuticalsNational Institute of General Medical SciencesAmerican Heart Association
- Keywords
- MedicineDosingInterquartile rangeCardiopulmonary resuscitationEpinephrineExtracorporeal cardiopulmonary resuscitationAnesthesiaIntensive careResuscitationEmergency medicineInternal medicineIntensive care medicine
- Has abstract in OpenAlex
- yes