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. 2025 Jul 30.
doi: 10.1097/CCM.0000000000006804. Online ahead of print.

Epinephrine Before Defibrillation in Children With Initially Shockable In-Hospital Cardiac Arrest

Morgan B Swanson  1 , Javier J Lasa  2 , Paul S Chan  3 , Ryan W Morgan  4 , Robert M Sutton  4 , Alexis A Topjian  4 , Dianne L Atkins  1 , Sarah E Haskell  1 , Tia T Raymond  5 , Saket Girotra  6 ; American Heart Association’s Get With The Guidelines—Resuscitation Investigators
Collaborators, Affiliations

Epinephrine Before Defibrillation in Children With Initially Shockable In-Hospital Cardiac Arrest

Morgan B Swanson et al. Crit Care Med. .

Abstract

Objective: Assess prevalence of epinephrine before or during the same minute as defibrillation and association with clinical outcomes in pediatric in-hospital cardiac arrest (IHCA).

Design: Retrospective cohort study.

Setting: We used 2000-2020 data from the American Heart Association's Get With the Guidelines-Resuscitation Registry.

Patients: Children (< 18 yr) with index IHCA with an initial shockable rhythm of ventricular fibrillation or pulseless ventricular tachycardia and at least one defibrillation attempt.

Interventions: None.

Measurements and main results: The primary exposure was epinephrine administration before or during the same minute as defibrillation. Study outcomes were survival to hospital discharge (primary outcome), return of spontaneous circulation (ROSC) for greater than or equal to 20 min, and survival with favorable neurologic outcome. Propensity-score matching was used for confounding adjustment. Among 492 pediatric IHCA index events with an initial shockable rhythm, median age was 7 years and 351 (71%) were in the ICU. Overall, 232 (47%) children received either epinephrine before defibrillation (29%) or during the same minute as defibrillation (18%). In unadjusted analyses, proportions of survival to hospital discharge (37.1% vs. 51.2%), ROSC (74.6% vs. 84.6%), and survival with favorable neurologic outcome (22.1% vs. 40.4%) were lower in the epinephrine before or during the same minute as defibrillation group. However, in adjusted analyses using propensity score matching with exact matching on time to defibrillation category, epinephrine before or during the same minute as defibrillation was not associated with hospital survival (odds ratio [OR] 0.84, 0.46-1.56), ROSC (OR 0.97, 0.48-1.96), or favorable neurologic outcome (OR 0.52, 0.27-1.00).

Conclusions: Contrary to current guidelines, nearly 50% of pediatric IHCA due to an initial shockable rhythm receive epinephrine before, or during the same minute, as first defibrillation. Although survival outcomes were numerically lower in epinephrine before defibrillation group, the association was not statistically significant.

Keywords: cardiac arrest; epinephrine; pediatrics; resuscitation; treatment outcomes.

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Conflict of interest statement

Dr. Swanson received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (F30HD100074). Drs. Swanson, Chan, and Girotra received support for article research from the National Institutes of Health (NIH). Dr. Chan received funding from the National, Heart, Lung, and Blood Institute (NHLBI) (R01HL160734). Dr. Morgan received support from the NHLBI (K23HL148541). Dr. Sutton’s institution received funding from the NIH. Dr. Atkins disclosed she is a member of the Data Safety and Monitoring Board for the Pediatric Heart Network. Dr. Haskell’s institution received funding from the NHLBI (R01HL146363). Dr. Paid Dr. Raymond was a consultant Adjudication Committee for the PHN COMPASS trial received funding from New England Research Institute, PLLC. Dr. Girotra’s institution received funding from the NHLBI (R01HL160734, R01HL166305, and R56HL158803). The content is solely the responsibility of the authors and does not necessarily reflect the views of the NIH or the U.S. Department of Health and Human Services. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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