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Impact of Different Initial Epinephrine Treatment Time Points on the Early Postresuscitative Hemodynamic Status of Children With Traumatic Out-of-hospital Cardiac Arrest

View Article: PubMed Central - PubMed

ABSTRACT

The postresuscitative hemodynamic status of children with traumatic out-of-hospital cardiac arrest (OHCA) might be impacted by the early administration of epinephrine, but this topic has not been well addressed. The aim of this study was to analyze the early postresuscitative hemodynamics, survival, and neurologic outcome according to different time points of first epinephrine treatment among children with traumatic OHCA.

Information on 388 children who presented to the emergency departments of 3 medical centers and who were treated with epinephrine for traumatic OHCA during the study period (2003–2012) was retrospectively collected. The early postresuscitative hemodynamic features (cardiac functions, end-organ perfusion, and consciousness), survival, and neurologic outcome according to different time points of first epinephrine treatment (early: <15, intermediate: 15–30, and late: >30 minutes after collapse) were analyzed.

Among 165 children who achieved sustained return of spontaneous circulation, 38 children (9.8%) survived to discharge and 12 children (3.1%) had good neurologic outcomes. Early epinephrine increased the postresuscitative heart rate and blood pressure in the first 30 minutes, but ultimately impaired end-organ perfusion (decreased urine output and initial creatinine clearance) (all P < 0.05). Early epinephrine treatment increased the chance of achieving sustained return of spontaneous circulation, but did not increase the rates of survival and good neurologic outcome.

Early epinephrine temporarily increased heart rate and blood pressure in the first 30 minutes of the postresuscitative period, but impaired end-organ perfusion. Most importantly, the rates of survival and good neurologic outcome were not significantly increased by early epinephrine administration.

No MeSH data available.


Related in: MedlinePlus

Primary outcomes of the patients. Superscript ‘†’ indicates the survival to discharge rate (P = 0.234) and superscript ‘‡’ indicates the frequency of good neurologic outcome (P = 0.874), which did not significantly differ among the 3 groups (chi-square test). ED = emergency department, EMS = emergency medical system, OHCA = out-of-hospital cardiac arrest, PCPCS = Pediatric Cerebral Performance Category Scale, ROSC = return of spontaneous circulation.
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Figure 1: Primary outcomes of the patients. Superscript ‘†’ indicates the survival to discharge rate (P = 0.234) and superscript ‘‡’ indicates the frequency of good neurologic outcome (P = 0.874), which did not significantly differ among the 3 groups (chi-square test). ED = emergency department, EMS = emergency medical system, OHCA = out-of-hospital cardiac arrest, PCPCS = Pediatric Cerebral Performance Category Scale, ROSC = return of spontaneous circulation.

Mentions: The primary outcome results are presented in Figure 1. Information on 388 children was analyzed in this study, and most of the children (n = 223, 57.5%) received an initial dose of epinephrine in the period 15 to 30 minutes after collapse, followed by the time periods <15 minutes (n = 97, 25%) and >30 minutes (n = 68, 17.5%). A total of 38 children (9.8%) survived until discharge, and only 12 children (3.1%) presented with good neurologic outcomes at discharge. The characteristics and factors associated with sustained ROSC are presented in Table 1. Road traffic injuries (RTIs) and motor vehicle crashes (MVCs) were the major causes of traumatic OHCA. Prehospital BLS was performed in 99.7% of EMS-transported patients and in only 33.3% of non-EMS-transported patients. Nonintravenous epinephrine was initially administered to 67 children (17.3%). In this study, most (n = 373, 96.1%) of the patients suffered cardiac arrest at the scene, immediately after accident, and only 15 patients had initial measureable blood pressure or heart rate before or during transportation. All 15 patients had hypotension, and 12 patients presented bradycardia (the remainder presented tachycardia). Unfortunately, these 15 patients suffered cardiac arrest before arriving to the hospital. Among the 165 patients who achieved sustained ROSC in the ED, most patients (n = 162, 98.2%) survived more than 1 hour. Thirty-two children with sustained ROSC received emergency surgery immediately, before being admitted to the SICU; the remaining 130 children were directly admitted to the SICU. The power calculation of our sample size was 0.86.


Impact of Different Initial Epinephrine Treatment Time Points on the Early Postresuscitative Hemodynamic Status of Children With Traumatic Out-of-hospital Cardiac Arrest
Primary outcomes of the patients. Superscript ‘†’ indicates the survival to discharge rate (P = 0.234) and superscript ‘‡’ indicates the frequency of good neurologic outcome (P = 0.874), which did not significantly differ among the 3 groups (chi-square test). ED = emergency department, EMS = emergency medical system, OHCA = out-of-hospital cardiac arrest, PCPCS = Pediatric Cerebral Performance Category Scale, ROSC = return of spontaneous circulation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998412&req=5

Figure 1: Primary outcomes of the patients. Superscript ‘†’ indicates the survival to discharge rate (P = 0.234) and superscript ‘‡’ indicates the frequency of good neurologic outcome (P = 0.874), which did not significantly differ among the 3 groups (chi-square test). ED = emergency department, EMS = emergency medical system, OHCA = out-of-hospital cardiac arrest, PCPCS = Pediatric Cerebral Performance Category Scale, ROSC = return of spontaneous circulation.
Mentions: The primary outcome results are presented in Figure 1. Information on 388 children was analyzed in this study, and most of the children (n = 223, 57.5%) received an initial dose of epinephrine in the period 15 to 30 minutes after collapse, followed by the time periods <15 minutes (n = 97, 25%) and >30 minutes (n = 68, 17.5%). A total of 38 children (9.8%) survived until discharge, and only 12 children (3.1%) presented with good neurologic outcomes at discharge. The characteristics and factors associated with sustained ROSC are presented in Table 1. Road traffic injuries (RTIs) and motor vehicle crashes (MVCs) were the major causes of traumatic OHCA. Prehospital BLS was performed in 99.7% of EMS-transported patients and in only 33.3% of non-EMS-transported patients. Nonintravenous epinephrine was initially administered to 67 children (17.3%). In this study, most (n = 373, 96.1%) of the patients suffered cardiac arrest at the scene, immediately after accident, and only 15 patients had initial measureable blood pressure or heart rate before or during transportation. All 15 patients had hypotension, and 12 patients presented bradycardia (the remainder presented tachycardia). Unfortunately, these 15 patients suffered cardiac arrest before arriving to the hospital. Among the 165 patients who achieved sustained ROSC in the ED, most patients (n = 162, 98.2%) survived more than 1 hour. Thirty-two children with sustained ROSC received emergency surgery immediately, before being admitted to the SICU; the remaining 130 children were directly admitted to the SICU. The power calculation of our sample size was 0.86.

View Article: PubMed Central - PubMed

ABSTRACT

The postresuscitative hemodynamic status of children with traumatic out-of-hospital cardiac arrest (OHCA) might be impacted by the early administration of epinephrine, but this topic has not been well addressed. The aim of this study was to analyze the early postresuscitative hemodynamics, survival, and neurologic outcome according to different time points of first epinephrine treatment among children with traumatic OHCA.

Information on 388 children who presented to the emergency departments of 3 medical centers and who were treated with epinephrine for traumatic OHCA during the study period (2003&ndash;2012) was retrospectively collected. The early postresuscitative hemodynamic features (cardiac functions, end-organ perfusion, and consciousness), survival, and neurologic outcome according to different time points of first epinephrine treatment (early: &lt;15, intermediate: 15&ndash;30, and late: &gt;30&#8202;minutes after collapse) were analyzed.

Among 165 children who achieved sustained return of spontaneous circulation, 38 children (9.8%) survived to discharge and 12 children (3.1%) had good neurologic outcomes. Early epinephrine increased the postresuscitative heart rate and blood pressure in the first 30&#8202;minutes, but ultimately impaired end-organ perfusion (decreased urine output and initial creatinine clearance) (all P&#8202;&lt;&#8202;0.05). Early epinephrine treatment increased the chance of achieving sustained return of spontaneous circulation, but did not increase the rates of survival and good neurologic outcome.

Early epinephrine temporarily increased heart rate and blood pressure in the first 30&#8202;minutes of the postresuscitative period, but impaired end-organ perfusion. Most importantly, the rates of survival and good neurologic outcome were not significantly increased by early epinephrine administration.

No MeSH data available.


Related in: MedlinePlus