title: 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.
authors.affiliation: From the Department of Emergency Medicine (Y-RL, C-FC, C-YC, CHC), Changhua Christian Hospital, Changhua, Taiwan; School of Medicine (Y-RL), Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine (Y-RL), Chung Shan Medical University, Taichung, Taiwan; Department of Anesthesiology (Y-JS), Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biological Science and Technology (WB, C-YC, W-LC), National Chiao Tung University, Hsinchu, Taiwan; Interdisciplinary Graduate Program in Genetic Engineering (WB), Graduate School, Kasetsart University, Bangkhen campus, Bangkok, Thailand; Bioresource Collection and Research Center (H-EL), Food Industry Research and Development Institute, Hsinchu, Taiwan; Department of Emergency Medicine (C-JL), Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; and Department of Public Health (C-JL), College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yan-Ren
authors.initials: YR
authors.lastname: Lin
authors.forename: Yuan-Jhen
authors.initials: YJ
authors.lastname: Syue
authors.forename: Waradee
authors.initials: W
authors.lastname: Buddhakosai
authors.forename: Huai-En
authors.initials: HE
authors.lastname: Lu
authors.forename: Chin-Fu
authors.initials: CF
authors.lastname: Chang
authors.forename: Chih-Yu
authors.initials: CY
authors.lastname: Chang
authors.forename: Cheng Hsu
authors.initials: CH
authors.lastname: Chen
authors.forename: Wen-Liang
authors.initials: WL
authors.lastname: Chen
authors.forename: Chao-Jui
authors.initials: CJ
authors.lastname: Li
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D061345:Early Medical Intervention; D004837:Epinephrine / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D004837:Epinephrine