- Children experiencing trauma-related out-of-hospital cardiac arrest (OHCA) due to hemorrhagic shock (HS) and who achieved return of spontaneous circulation (ROSC) were less likely to survive if given epinephrine early.
- Authors: “We suspect that early epinephrine administration should not be considered the first step in resuscitating children with traumatic OHCA due to major hemorrhage.”
- Causation not established; prospective studies needed.
Why this matters
- Epinephrine has been linked to ROSC in adult OHCA, and to benefits in nontraumatic pediatric cardiac arrest.
- 68.4% (348) had HS OHCA.
- Early epinephrine (n=131) was linked to sustained ROSC (HS group, P=.017; non-HS group, P=.001), but not to survival to discharge or good neurological outcomes.
- In HS group, early epinephrine vs late correlated with metabolic acidosis, greater cardiac output, less urine output.
- Upon regression analysis in HS group, mortality with early epinephrine: HR, 4.52 (95% CI, 2.73-15.91).
- 3-center records analysis of children experiencing traumatic HS- and non-HS-related OHCA who received epinephrine (n=509).
- They assessed outcomes after ROSC among those receiving epinephrine early (30 minutes).
- Funding: Changhua Christian Hospital, Taiwan.
- Survival bias could affect mortality link.