Pilot Comparison of Three Cardiopulmonary Resuscitation Medication Dosing Strategies in Overweight Children

Abstract

OBJECTIVES Dose calculations using three variations of patient weight estimates (actual body weight [ABW], ideal body weight [IBW], and the Broselow Pediatric Emergency Tape [BPET, a length-based weight estimation tool]) were compared to administered doses of cardiopulmonary resuscitation medications in overweight and obese children to assess for differences in dose. METHODS This retrospective cohort analysis included 54 consecutive pediatric patients who underwent emergency resuscitation at UMass Memorial Medical Center between January 2000 and October 2008. Patients were identified using ICD-9 codes related to cardiopulmonary resuscitation. Patients were included if they were overweight or obese, less than 12 years of age, less than 146 centimeters in length, and received emergency resuscitation medication(s). Doses of administered medications were recorded and compared to potential doses calculated based on ABW, IBW and the dose recommended by the BPET. Dose differences greater than 10% were considered clinically significant and dose differences greater than 20% were considered to be potential medication errors. RESULTS Out of 54 possible patients, four overweight patients were included; none were obese. Ten total medication doses were assessed (minimum two per patient). In all patients, at least one comparator dose varied by greater than 20% from the administered dose. Four out of 10 doses calculated according to ABW, eight out of 10 doses calculated with IBW, and eight out of 10 doses recommended by the BPET all differed by greater than 20% from the administered dose. CONCLUSIONS Dosing variations were observed when the dose received was compared to dosing using three variants of patient weight estimates. The largest dosing differences were observed upon comparison of the administered dose versus the dose recommended by the BPET.

Is there evidence that length-based tapes with precalculated drug doses increase the accuracy of drug dose calculations in children? A systematic review

“…There were 18 studies included in the analysis (Fig. 1), the details of which are shown in Table 2 [12,14,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. They were published from 2001 to 2023 and conducted in five countries, with 14 studies (77.8%) [14,[28][29][30][31][33][34][35][36][38][39][40][41][42] originating in the United States.…”

“…1), the details of which are shown in Table 2 [12,14,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. They were published from 2001 to 2023 and conducted in five countries, with 14 studies (77.8%) [14,[28][29][30][31][33][34][35][36][38][39][40][41][42] originating in the United States. Half of the studies were conducted in an in-hospital environment [12,32,33,35,37,38,40,42,43], and half in an out-of-hospital setting or with EMS personnel [14,[28][29][30][31]34,…”

“…They were published from 2001 to 2023 and conducted in five countries, with 14 studies (77.8%) [14,[28][29][30][31][33][34][35][36][38][39][40][41][42] originating in the United States. Half of the studies were conducted in an in-hospital environment [12,32,33,35,37,38,40,42,43], and half in an out-of-hospital setting or with EMS personnel [14,[28][29][30][31]34,36,39,41]. There was a preponderance of simulation studies (14 studies, 77.8%) [12,14,[29][30][31][32][33][34][35][36][37][38]40,41].…”

“…The details of the risk of bias for each study are shown in Fig. 2 [12,14,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43].…”

Using the Mercy Method to Estimate Ideal Body Weight in Children: A Description and Validation of a New Methodology

“…The ability to estimate IBW is important since many drugs used in the resuscitation of critically ill or injured children are hydrophilic, and since poor outcomes in obese children have been ascribed to dosing errors based on TBW estimations [8,9]. An additional method that could be used to estimate both TBW and IBW would, therefore, be useful for clinicians caring for sick children requiring emergency care.…”