Division of Cardiac Critical Care, Department of Pediatrics, Medical City Children's Hospital, Dallas, TX.
Department of Biostatistics, University of Pennsylvania, Philadelphia, PA.
Pediatr Crit Care Med. 2019 May;20(5):405-416. doi: 10.1097/PCC.0000000000001863.
To evaluate the variation of hospital rates of delayed epinephrine administration in pediatric patients with nonshockable in-hospital cardiac arrest, and the association of those rates with event, 24-hour, and overall survival to hospital discharge.
A retrospective evaluation was performed. Delayed epinephrine was defined as greater than 5 minutes between the time the need for chest compressions was identified and epinephrine was administered. The main outcome was the association of hospital rate of delayed epinephrine administration with survival to hospital discharge. Secondary outcomes were event and 24-hour survival. Evaluation used hierarchical logistic regression and included 13 patient/event-level and seven hospital-level factors.
Hospitals with greater than 6 months data in the American Heart Association's Get With the Guidelines-Resuscitation registry (2000-2016) and greater than or equal to five total pediatric cardiac arrests with nonshockable rhythm.
Children less than 18 years old with index nonshockable in-hospital cardiac arrest treated with greater than or equal to one epinephrine dose.
None.
One-thousand four-hundred sixty-two patients at 69 hospitals were included: 218 patients (14.9%) had epinephrine delay rates ranging from 0% to 80% of events (median, 15.6%; interquartile range, 7-25%). The median and interquartile range of hospital level delay was 16% (7-25%). Patient/event-level predictors of delayed epinephrine were asystole (odds ratio, 1.54 [95% CI, 1.10-2.16]) and insertion of an endotracheal tube (odds ratio, 1.86 [95% CI, 1.27-2.73]). Hospital size less than 200 compared with greater than or equal to 500 beds (odds ratio, 3.07 [95% CI, 1.22-7.73]) and ICU location (odds ratio, 0.51 [95% CI, 0.36-0.74]) were associated with epinephrine delay rates. After adjustment, increasing quartiles of epinephrine delay were associated with lower patient and hospital-level return of spontaneous circulation (p = 0.019, p = 0.006) and 24-hour survival (p = 0.018, p = 0.002) respectively, but not survival to discharge (p = 0.20, p = 0.24).
Delayed epinephrine administration following pediatric nonshockable in-hospital cardiac arrest varies significantly between hospitals. Hospitals with higher rates of delayed epinephrine administration had worse patient- and hospital-level outcomes after adjusting for multiple patient- and hospital-level factors. Delayed epinephrine administration may directly contribute to increased mortality risk and/or may be a marker of unmeasured elements of hospital resuscitation performance.
评估儿科非心搏骤停院内心脏骤停患者肾上腺素延迟给药的医院发生率的变化，以及这些发生率与事件、24 小时和整体出院存活率的关系。
回顾性评估。延迟给予肾上腺素定义为从需要进行胸外按压到给予肾上腺素之间超过 5 分钟。主要结局是医院给予肾上腺素延迟的发生率与出院存活率的关系。次要结局为事件和 24 小时存活率。评估使用分层逻辑回归，包括 13 个患者/事件水平和 7 个医院水平的因素。
美国心脏协会 Get With the Guidelines-Resuscitation 注册中心（2000-2016 年）中数据超过 6 个月的医院，以及至少有 5 例非可电击节律的儿科心脏骤停总例数。
接受大于或等于 1 剂肾上腺素治疗的指数非可电击院内心脏骤停的 1462 例年龄小于 18 岁的儿童。
无。
在 69 家医院中纳入了 1462 例患者：218 例患者（14.9%）的肾上腺素延迟率在事件的 0%至 80%之间（中位数，15.6%；四分位距，7-25%）。医院水平延迟的中位数和四分位距为 16%（7-25%）。患者/事件水平预测肾上腺素延迟的因素有心搏停止（优势比，1.54[95%CI，1.10-2.16]）和插入气管内管（优势比，1.86[95%CI，1.27-2.73]）。与大于或等于 500 张床的医院相比，床位数小于 200 张（优势比，3.07[95%CI，1.22-7.73]）和 ICU 位置（优势比，0.51[95%CI，0.36-0.74]）与肾上腺素延迟率相关。调整后，肾上腺素延迟的四分位间距与患者和医院水平自主循环恢复率（p = 0.019，p = 0.006）和 24 小时存活率（p = 0.018，p = 0.002）降低相关，但与出院存活率无关（p = 0.20，p = 0.24）。
儿科非心搏骤停院内心脏骤停后肾上腺素的延迟给药在医院之间存在显著差异。调整了多个患者和医院水平的因素后，延迟给予肾上腺素的医院的患者和医院水平结局更差。肾上腺素延迟给药可能直接导致死亡率风险增加，或者可能是医院复苏性能未测量因素的标志。
