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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.


Among the patients with sustained ROSC (n = 165), the time from the initial epinephrine dose to sustained ROSC was shortest in the group of children administered intermediate epinephrine (15–30 minutes) (P < 0.05). ROSC = return of spontaneous circulation.
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Figure 2: Among the patients with sustained ROSC (n = 165), the time from the initial epinephrine dose to sustained ROSC was shortest in the group of children administered intermediate epinephrine (15–30 minutes) (P < 0.05). ROSC = return of spontaneous circulation.

Mentions: Among the 97 children who received early epinephrine, 52.6% (n = 51) achieved sustained ROSC. This percentage was significantly higher than for those who received intermediate (n = 92, 41.3%) and late (n = 22, 32.4%) epinephrine (P = 0.030). However, the resuscitation time (from initial epinephrine dose to sustained ROSC) was the shortest in patients who received intermediate epinephrine (P < 0.05) (Figure 2).


Impact of Different Initial Epinephrine Treatment Time Points on the Early Postresuscitative Hemodynamic Status of Children With Traumatic Out-of-hospital Cardiac Arrest
Among the patients with sustained ROSC (n = 165), the time from the initial epinephrine dose to sustained ROSC was shortest in the group of children administered intermediate epinephrine (15–30 minutes) (P < 0.05). ROSC = return of spontaneous circulation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Among the patients with sustained ROSC (n = 165), the time from the initial epinephrine dose to sustained ROSC was shortest in the group of children administered intermediate epinephrine (15–30 minutes) (P < 0.05). ROSC = return of spontaneous circulation.
Mentions: Among the 97 children who received early epinephrine, 52.6% (n = 51) achieved sustained ROSC. This percentage was significantly higher than for those who received intermediate (n = 92, 41.3%) and late (n = 22, 32.4%) epinephrine (P = 0.030). However, the resuscitation time (from initial epinephrine dose to sustained ROSC) was the shortest in patients who received intermediate epinephrine (P < 0.05) (Figure 2).

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.