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August 25, 2015

Pediatric Pulseless Arrest With “Nonshockable” RhythmDoes Faster Time to Epinephrine Improve Outcome?

Author Affiliations
  • 1Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 2Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
  • 3Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
  • 4Department of Neurology, Harvard Medical School, Boston, Massachusetts
  • 5Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
JAMA. 2015;314(8):776-777. doi:10.1001/jama.2015.9527

In this issue of JAMA, Andersen et al1 report findings from their observational study based on data from a national registry of 15 959 pediatric (<18 years) in-hospital cardiac arrests from 2000 to 2014, which included 1558 children (9.8%) who received at least 1 dose of epinephrine for nonshockable rhythms (ie, pulseless electrical activity or asystole) during cardiopulmonary resuscitation (CPR). Among these children (median age, 9 months), 50% received epinephrine during the same whole minute as the patient lost their pulse or the next whole minute; only 15% received the first dose of epinephrine after 5 minutes of CPR. In children receiving epinephrine for nonshockable rhythms, the authors found that each minute of delay in epinephrine administration was associated with adverse outcomes (ie, lower risk of return of spontaneous circulation [ROSC], survival at 24 hours, and discharge from hospital with favorable outcome).

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