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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

Variations in postresuscitation cardiac function. A, Heart rate and B, MAP were analyzed according to the different initial epinephrine treatment time points. The increased cardiac function caused by early and intermediate epinephrine (<15 minutes and 15–30 minutes from collapse) was predominant only during the first half hour of the postresuscitation period. Superscript ‘†’ indicates number of patients with missing information. MAP = mean arterial blood pressure.
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Figure 3: Variations in postresuscitation cardiac function. A, Heart rate and B, MAP were analyzed according to the different initial epinephrine treatment time points. The increased cardiac function caused by early and intermediate epinephrine (<15 minutes and 15–30 minutes from collapse) was predominant only during the first half hour of the postresuscitation period. Superscript ‘†’ indicates number of patients with missing information. MAP = mean arterial blood pressure.

Mentions: Tachycardia (47.3%), hypotension (43.0%), and sinus rhythm (68.5%) were the most common heart-related features during the first hour after achieving sustained ROSC (all P < 0.05). Furthermore, we found that postresuscitation tachycardia was predominant in patients who received early and intermediate epinephrine relative to patients who received late epinephrine. However, postresuscitation hypertension was only predominant in patients who received early epinephrine treatment (Table 2). Finally, the variations in postresuscitation heart rate and blood pressure according to the different treatment time points were analyzed. The increased heart rate and blood pressure caused by early epinephrine administration was predominant only in the first half hour of the postresuscitation period (Figure 3).


Impact of Different Initial Epinephrine Treatment Time Points on the Early Postresuscitative Hemodynamic Status of Children With Traumatic Out-of-hospital Cardiac Arrest
Variations in postresuscitation cardiac function. A, Heart rate and B, MAP were analyzed according to the different initial epinephrine treatment time points. The increased cardiac function caused by early and intermediate epinephrine (<15 minutes and 15–30 minutes from collapse) was predominant only during the first half hour of the postresuscitation period. Superscript ‘†’ indicates number of patients with missing information. MAP = mean arterial blood pressure.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Variations in postresuscitation cardiac function. A, Heart rate and B, MAP were analyzed according to the different initial epinephrine treatment time points. The increased cardiac function caused by early and intermediate epinephrine (<15 minutes and 15–30 minutes from collapse) was predominant only during the first half hour of the postresuscitation period. Superscript ‘†’ indicates number of patients with missing information. MAP = mean arterial blood pressure.
Mentions: Tachycardia (47.3%), hypotension (43.0%), and sinus rhythm (68.5%) were the most common heart-related features during the first hour after achieving sustained ROSC (all P < 0.05). Furthermore, we found that postresuscitation tachycardia was predominant in patients who received early and intermediate epinephrine relative to patients who received late epinephrine. However, postresuscitation hypertension was only predominant in patients who received early epinephrine treatment (Table 2). Finally, the variations in postresuscitation heart rate and blood pressure according to the different treatment time points were analyzed. The increased heart rate and blood pressure caused by early epinephrine administration was predominant only in the first half hour of the postresuscitation period (Figure 3).

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