Pediatric OHCA from trauma: early epinephrine linked to harm amid hemorrhagic shock

  • Lin YR & al.
  • Crit Care
  • 27 Mar 2019

  • International Clinical Digest
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Takeaway

  • 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. 

Key results

  • 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).

Study design

  • 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.

Limitations

  • Retrospective.
  • Survival bias could affect mortality link.

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