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Observational Study
. 2023 Nov 1;24(11):e531-e539.
doi: 10.1097/PCC.0000000000003323. Epub 2023 Jul 13.

Epinephrine Dosing Use During Extracorporeal Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort

Nicholas M Kucher  1 , Alexandra M Marquez  1 , Anne-Marie Guerguerian  1 , Michael-Alice Moga  1   2 , Mariella Vargas-Gutierrez  1 , Mark Todd  3 , Osami Honjo  4 , Christoph Haller  4 , Geraldine Goco  1 , Alejandro A Floh  1   2
Affiliations
Observational Study

Epinephrine Dosing Use During Extracorporeal Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort

Nicholas M Kucher et al. Pediatr Crit Care Med. .

Abstract

Objectives: During pediatric cardiac arrest, contemporary guidelines recommend dosing epinephrine at regular intervals, including in patients requiring extracorporeal membrane oxygenation (ECMO). The impact of epinephrine-induced vasoconstriction on systemic afterload and venoarterial ECMO support is not well-defined.

Design: Nested retrospective observational study within a single center. The primary exposure was time from last dose of epinephrine to initiation of ECMO flow; secondary exposures included cumulative epinephrine dose and arrest time. Systemic afterload was assessed by mean arterial pressure and use of systemic vasodilator therapy; ECMO pump flow and Vasoactive-Inotrope Score (VIS) were used as measures of ECMO support. Clearance of lactate was followed post-cannulation as a marker of systemic perfusion.

Setting: PICU and cardiac ICU in a quaternary-care center.

Patients: Patients 0-18 years old who required ECMO cannulation during resuscitation over the 6 years, 2014-2020. Patients were excluded if ECMO was initiated before cardiac arrest or if the resuscitation record was incomplete.

Interventions: None.

Measurements and main results: A total of 92 events in 87 patients, with 69 events having complete data for analysis. The median (interquartile range) of total epinephrine dosing was 65 mcg/kg (37-101 mcg/kg), with the last dose given 6 minutes (2-16 min) before the initiation of ECMO flows. Shorter interval between last epinephrine dose and ECMO initiation was associated with increased use of vasodilators within 6 hours of ECMO ( p = 0.05), but not with mean arterial pressure after 1 hour of support (estimate, -0.34; p = 0.06). No other associations were identified between epinephrine delivery and mean arterial blood pressure, vasodilator use, pump speed, VIS, or lactate clearance.

Conclusions: There is limited evidence to support the idea that regular dosing of epinephrine during cardiac arrest is associated with increased in afterload after ECMO cannulation. Additional studies are needed to validate findings against ECMO flows and clinically relevant outcomes.

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Conflict of interest statement

Dr. Guerguerian disclosed the off-label product use of extracorporeal membrane oxygenation membranes in neonates and children. Dr. Floh received funding from the Office of the Chief Coroner, Ontario. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

    1. Morimura N, Sakamoto T, Nagao K, et al.: Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A review of the Japanese literature. Resuscitation. 2011; 82:10–14
    1. Kim SJ, Kim HJ, Lee HY, et al.: Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: A meta-analysis. Resuscitation. 2016; 103:106–116
    1. Lasa J, Rogers R, Localio R, et al.: Extracorporeal-cardiopulmonary resuscitation (E-CPR) during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge: A report from the American Heart Association’s Get With the Guidelines®-Resuscitation Registry (GWTG-R). Circulation. 2015; 133:165–176
    1. Meert KL, Guerguerian AM, Barbaro R, et al.; Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA) Trial Investigators: Extracorporeal cardiopulmonary resuscitation: One-year survival and neurobehavioral outcome among infants and children with in-hospital cardiac arrest*. Crit Care Med. 2019; 47:393–402
    1. Yoo BA, Yoo S, Choi ES, et al.: Extracorporeal cardiopulmonary resuscitation in infants: Outcomes and predictors of mortality. J Chest Surg. 2023; 56:162–170

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