Correlation of Adrenaline Doses With the Outcome of Paediatric Out-of-hospital Cardiac Arrest: Secondary Analysis of the SOS-KANTO 2012 Study

Abstract

Background Out-of-hospital cardiac arrest (OHCA) is very rare in the paediatric population, with an annual incidence of 2-9 cases per 1,000,000 children. The predictive factors for survival included a shorter interval between the time of arrest and hospital arrival, a palpable pulse on presentation in the emergency department (ED), a shorter duration of resuscitation in the ED, and the administration of fewer doses of adrenaline in the ED. This study was conducted to evaluated the interrelationship between the paediatric OHCA outcome and the number of adrenaline doses administered during resuscitation. Methods The SOS-KANTO 2012 study had enrolled all OHCA patients who were transported to the participant hospitals by emergency medical service personnel. After screening the available data, we included paediatric OHCA patients (aged ≤ 18 years) in this study. The primary outcome was the return of spontaneous circulation (ROSC) and the number of adrenaline doses that were administered, and the secondary outcome was the neurological outcome at 1 month after the OHCA in relation to the number of adrenaline doses. Results Two hundred sixty-seven patients were included in the final analyses. During CPR, 62 and 205 paediatric patients did and did not achieve ROSC, respectively. Patients who survived to one month after the OHCA received fewer adrenaline doses than patients who died, although there was no significant intergroup difference (3 [1.75-5.25], vs. 4 [2.5-6], p=0.319). Patients with a good neurological outcome (PCPC 1-2) received fewer doses of adrenaline than those with an unfavourable neurological outcome (PCPC 3-6), but intergroup difference was not significant. Fewer doses of adrenaline were associated with an improved rate of successful ROSC (odds ration = 0.80,95% confidence interval = 0.69-0.92, p<0.01). Conclusion The present study reports associations of the neurological outcomes with adrenaline doses in paediatric patients with OHCA. More than three adrenaline doses were associated with poor neurological outcome, and a favourable outcome occurred infrequently. By using information that was only available up to 1 month after the OHCA, we found that a higher number of adrenaline doses was associated with poor neurological outcome.