Impact of Different Initial Epinephrine Treatment Time Points on the Early Postresuscitative Hemodynamic Status of Children With Traumatic Out-of-hospital Cardiac Arrest

Abstract

The postresuscitative hemodynamic status of children with traumatic out-of-hospital cardiac arrest (OHCA) might be impacted by the early administration of epinephrine, but this topic has not been well addressed. The aim of this study was to analyze the early postresuscitative hemodynamics, survival, and neurologic outcome according to different time points of first epinephrine treatment among children with traumatic OHCA.Information on 388 children who presented to the emergency departments of 3 medical centers and who were treated with epinephrine for traumatic OHCA during the study period (2003–2012) was retrospectively collected. The early postresuscitative hemodynamic features (cardiac functions, end-organ perfusion, and consciousness), survival, and neurologic outcome according to different time points of first epinephrine treatment (early: <15, intermediate: 15–30, and late: >30 minutes after collapse) were analyzed.Among 165 children who achieved sustained return of spontaneous circulation, 38 children (9.8%) survived to discharge and 12 children (3.1%) had good neurologic outcomes. Early epinephrine increased the postresuscitative heart rate and blood pressure in the first 30 minutes, but ultimately impaired end-organ perfusion (decreased urine output and initial creatinine clearance) (all P < 0.05). Early epinephrine treatment increased the chance of achieving sustained return of spontaneous circulation, but did not increase the rates of survival and good neurologic outcome.Early epinephrine temporarily increased heart rate and blood pressure in the first 30 minutes of the postresuscitative period, but impaired end-organ perfusion. Most importantly, the rates of survival and good neurologic outcome were not significantly increased by early epinephrine administration.

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

“…Es wurden der 2020 PLS COSTR 1541 [ 143 ], sowie einige zusätzliche Nicht-RCT für den RR berücksichtigt (Anhang RR 30; [ 715 – 725 ]). Ein kürzeres Zeitintervall bis zur ersten Verabreichung von Adrenalin ist bei Kindern sowohl für Kreislaufstillstände im Krankenhaus (IHCA) als auch außerhalb des Krankenhauses (OHCA) mit einem günstigeren Outcome verbunden.…”

Demographics of Pediatric OHCA Survivors With Postdischarge Diseases: A National Population-Based Follow-Up Study

“…Several studies have reported an OHCA survival rate of 6.7-10.2% and that at most 4% of patients have intact or functional neurological outcomes (1)(2)(3)(4)(5)(6)(7). Most pediatric survivors will have previously been subjected to high levels of physical or psychological stress from the resuscitation process and treatment procedures or even from the effects of high-dose drugs during their hospital stay (8)(9)(10)(11). Furthermore, postcardiac arrest syndrome and individual essential diseases (related to cardiac arrest) may potentially not only increase mortality during admission but also induce short/long-term postdischarge diseases (PDDs) (i.e., neurological defects, hypoxia-related organ dysfunction, and opportunistic infections) (10,(12)(13)(14)(15)(16).…”

Impact of Different Serum Potassium Levels on Postresuscitation Heart Function and Hemodynamics in Patients with Nontraumatic Out-of-Hospital Cardiac Arrest

“…Since a high level of serum potassium changes the resting membrane potential and decreases the ability to reach the action potential, we suspect that the impact of hyperkalemia on the regulation of the heart rhythm would be more obvious during the early postresuscitation period (the first hour after achieving sustained return of spontaneous circulation (ROSC)). We also suspect that the postresuscitation heart function and hemodynamic status (i.e., blood pressure, heart rate, heart rhythm, and the amount of urine output) established by CPR might be more easily destroyed by hyperkalemia [ 30 , 31 ].…”