@article{d37bc5c35aae447783033e8c49c527fb,
title = "The physiologic response to epinephrine and pediatric cardiopulmonary resuscitation outcomes",
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.",
keywords = "Adrenaline, Blood pressure, Cardiac arrest, Cardiopulmonary resuscitation, Epinephrine, Pediatrics",
author = "{the ICU-RESUS and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups} and Morgan, {Ryan W.} and Berg, {Robert A.} and Reeder, {Ron W.} and Carpenter, {Todd C.} and Deborah Franzon and Frazier, {Aisha H.} and Kathryn Graham and Meert, {Kathleen L.} and Nadkarni, {Vinay M.} and Naim, {Maryam Y.} and Bradley Tilford and Wolfe, {Heather A.} and Yates, {Andrew R.} and Sutton, {Robert M.} and Tageldin Ahmed and Bell, {Michael J.} and Robert Bishop and Matthew Bochkoris and Candice Burns and Carcillo, {Joseph A.} and Dean, {J. Michael} and Diddle, {J. Wesley} and Myke Federman and Richard Fernandez and Fink, {Ericka L.} and Friess, {Stuart H.} and Mark Hall and Hehir, {David A.} and Horvat, {Christopher M.} and Huard, {Leanna L.} and Tensing Maa and Arushi Manga and McQuillen, {Patrick S.} and Mourani, {Peter M.} and Daniel Notterman and Pollack, {Murray M.} and Anil Sapru and Carleen Schneiter and Sharron, {Matthew P.} and Neeraj Srivastava and Sarah Tabbutt and Shirley Viteri and David Wessel and Zuppa, {Athena F.}",
note = "Funding Information: This study was supported by the National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development (U01HD049934, UG1HD049981, UG1HD049983, UG1HD050096, UG1HD063108, UG1HD083166, UG1HD083170, and UG1HD083171) and National Heart, Lung, and Blood Institute (R01HL131544 and K23HL148541) and by the Children{\textquoteright}s Hospital of Philadelphia Research Institute Resuscitation Science Center. Funding Information: Ryan W. Morgan and Robert M. Sutton report funding paid to their institution from the NIH and volunteer leadership roles within the American Heart Association. Robert A. Berg reports funding paid to his institution from the NIH and membership on Data Safety Monitoring Boards. Ron W. Reeder, Todd C. Carpenter, Kathleen L. Meert, Heather A. Wolfe, and Andrew R. Yates report funding paid to their institutions from the NIH. Vinay M. Nadkarni reports funding paid to his institution from the NIH, Zoll Medical, Laerdal Medical/RQI Partners, and Nihon-Kohden and volunteer leadership roles in the Society of Critical Care Medicine, Citizen CPR Foundation, and International Liaison Committee on Resuscitation. Deborah Franzon, Aisha H. Frazier, Kathyrn Graham, Maryam Y. Naim, and Bradley Tilford have no relevant disclosures. Publisher Copyright: {\textcopyright} 2023, The Author(s).",
year = "2023",
month = dec,
doi = "10.1186/s13054-023-04399-5",
language = "English",
volume = "27",
journal = "Critical Care",
issn = "1364-8535",
number = "1",
}