Minutes Count in Using Epinephrine in Children with Cardiac Arrest

Two CHOP critical care physicians were co-authors of a recent national study that showed the crucial importance of rapidly using epinephrine when critically ill children suffer cardiac arrest in the hospital.

The study, published Aug. 25 in the Journal of the American Medical Association, showed that minutes count in using epinephrine in pediatric patients. Children who received their first dose of epinephrine within a few minutes after losing a pulse were more likely to survive than those in which epinephrine use was delayed.

Robert A. Berg, M.D. Robert A. Berg, MD, chief of Critical Care Medicine at CHOP, and Vinay M. Nadkarni, MD, who are national leaders in investigating pediatric cardiac arrests, collaborated in the current research with study leaders Drs. Lars Andersen and Michael Donnino, experts in critical care medicine for adult patients at Beth Israel Deaconess Medical Center in Boston.

The study team analyzed data on 1558 pediatric patients in the Get With the Guidelines—Resuscitation national registry sponsored by the American Heart Association. All the children in the study received at least one dose of epinephrine for cardiac arrests whose initial heart rhythm did not require an electric shock (defibrillation).

Vinay M. Nadkarni, MD Overall, 31 percent of the patients survived to hospital discharge. However, patients who received a first dose of epinephrine within five minutes of losing a pulse had a 33 percent survival rate, compared to 21 percent survival in patients who received epinephrine only after five minutes or longer. Among all 1558 patients, most received epinephrine within the first five minutes; the median time to first dose of epinephrine was just one minute, with worse outcomes with each minute of delay after that.

“Epinephrine has been used for decades for in-hospital cardiac arrests,” said Berg, “and previous studies by ourselves and others have focused on identifying the appropriate dosage in children. This study was the first to investigate the timing of epinephrine usage in children with cardiac arrest, and provides key information for best practices in saving patients’ lives. ”