Peri-arrest bolus epinephrine practices amongst pediatric resuscitation experts

Catherine E Ross; Margaret M Hayes; Monica E Kleinman; Michael W Donnino; Amy M Sullivan

doi:10.1016/j.resplu.2021.100200

Peri-arrest bolus epinephrine practices amongst pediatric resuscitation experts

Resusc Plus. 2022 Jan 14:9:100200. doi: 10.1016/j.resplu.2021.100200. eCollection 2022 Mar.

Authors

Catherine E Ross^{1

2}, Margaret M Hayes³, Monica E Kleinman⁴, Michael W Donnino^{2

3}, Amy M Sullivan⁵

Affiliations

¹ Division of Medicine Critical Care, Department of Pediatrics Boston Children's Hospital and Harvard Medical School, 333 Longwood Avenue, Boston, MA 02115, USA.
² Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 359 Brookline Avenue, Boston, MA 02115, USA.
³ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115, USA.
⁴ Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
⁵ Department of Medicine and Carl J. Shapiro Institute for Research and Education, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115, USA.

Abstract

Aim: To describe current practices of peri-arrest bolus epinephrine use amongst pediatric resuscitation experts in a multinational survey.

Methods: A 9-question survey was developed and electronically distributed to pediatric critical care physicians who are site investigators for the Pediatric Resuscitation Quality Collaborative (pediRES-Q) network. Institutional demographics were collected through the American Hospital Association 2018 Annual Survey and linked to responses. Descriptive statistics were used to characterize closed-ended responses, and qualitative content analysis to analyze open-ended responses.

Results: Of the 63 collaborative members invited to participate, 49 (78%) responded, representing 35 institutions in 9 countries. Forty-six of the 49 respondents (94%) reported that they would consider using peri-arrest bolus epinephrine during critical situations in patients not requiring cardiopulmonary resuscitation. Initial dosing strategies ranged from 0.1mcg/kg to 10mcg/kg, with the most commonly reported initial dose of 1mcg/kg by 25 of the 37 (68%) respondents who answered this question. Three of the 49 (6%) participants indicated that they would generally avoid using peri-arrest bolus epinephrine, citing lack of evidence to support its use.

Conclusions: In this multinational survey of pediatric resuscitation experts, endorsement of peri-arrest bolus epinephrine use was nearly universal, though a few clinicians cited lack of evidence to support this practice. There was a 100-fold difference in the range of initial weight-based doses reported, as well as a minority of clinicians who reported using non-weight-based dosing. Further research is needed to determine best practices, standardization of initial dosing, clinical factors that may warrant dosing modifications and associations with clinically important outcomes.

Keywords: Critical Care; Hypotension; Pediatric; Peri-arrest bolus epinephrine.

Abstract

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