Prehospital Epinephrine Improves Return of Circulation in Paediatric Patients With Cardiac Arrest

January 16, 2020

Prehospital epinephrine administration was associated with return of spontaneous circulation (ROSC) in paediatric patients who experienced an out-of-hospital cardiac arrest (OHCA), according to a study published in the Journal of the American College of Cardiology.

However, there were no significant differences in 1-month survival and favourable neurological outcome between those with and without epinephrine.

“We were concerned by the lack of randomised controlled trials and observational studies assessing the effectiveness of epinephrine administration in paediatric OHCA cases,” explained senior author Tetsuhisa Kitamura, MD, Osaka University’s Graduate School of Medicine, Osaka, Japan. “To better assess the effects of prehospital epinephrine administration, we retrospectively analysed data from 3,961 OHCA patients aged 8 to 17 years from the nationwide All-Japan Utstein Registry of the Fire and Disaster Management Agency database.”

The primary endpoint was 1-month survival. Secondary endpoints included 1-month survival with favourable neurological outcome -- defined as the cerebral performance category scale of 1 or 2 -- and prehospital ROSC.

Of the 3,961 patients, 306 (7.7%) received epinephrine and 3,655 (92.3%) did not. After time-dependent propensity score-sequential matching, 608 patients were included in the matched cohort. In the matched cohort, there were no significant differences between the epinephrine (10.2%) and no epinephrine groups (7.9%) in 1-month survival and favourable neurological outcome (3.6% vs 2.6%), whereas the epinephrine group had a higher likelihood of achieving prehospital ROSC (11.2% vs 3.3%).

“Our results showed that prehospital epinephrine administration was associated with improved return of circulation in paediatric patients with OHCA who did not respond to basic life support,” said Dr. Kitamura. “While we did not see any significant improvement in 1-month survival rates as a result of prehospital epinephrine administration, the return of blood flow is a necessary step in achieving a favourable neurological outcome. Therefore, we recommend that prehospital epinephrine administration should be included in international guidelines for cardiopulmonary resuscitation to enhance the survival of paediatric OHCA patients.”

Reference: https://www.sciencedirect.com/science/article/pii/S0735109719384517

SOURCE: Osaka University