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).
Tasker RC, Randolph AG. Pediatric Pulseless Arrest With “Nonshockable” Rhythm: Does Faster Time to Epinephrine Improve Outcome? JAMA. 2015;314(8):776–777. doi:10.1001/jama.2015.9527
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