早期肾上腺素与儿童院内心脏骤停血流动力学及预后的关联：多中心、整群随机临床试验重症监护病房复苏（ICU-RESUS）的二次分析
Association of Early Epinephrine with Hemodynamics and Outcome in Pediatric In-Hospital Cardiac Arrest: A Secondary Analysis of a Multicenter, Cluster-randomized Clinical Trial Intensive Care Unit Resuscitation (ICU-RESUS).
作者信息
Siems Ashley, Naim Maryam Y, Berg Robert A, Reeder Ron W, Ahmed Tageldin, Bell Michael J, Bishop Robert, Bochkoris Matthew, Burns Candice, Carcillo Joseph A, Carpenter Todd C, Diddle J Wesley, Federman Myke, Fernandez Richard, Fink Ericka L, Franzon Deborah, Frazier Aisha H, Friess Stuart H, Graham Kathryn, Hall Mark, Harding Monica L, Hehir David A, Horvat Christopher M, Huard Leanna L, Kilbaugh Todd J, Maa Tensing, Manga Arushi, McQuillen Patrick S, Meert Kathleen L, Mourani Peter M, Nadkarni Vinay M, Notterman Daniel, Pollack Murray M, Qunibi Danna W, Sapru Anil, Schneiter Carleen, Sharron Matthew P, Srivastava Neeraj, Tabbutt Sarah, Tilford Bradley, Viteri Shirley, Wessel David, Wolfe Heather A, Yates Andrew R, Zuppa Athena F, Morgan Ryan W, Sutton Robert M
机构信息
Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Ann Am Thorac Soc. 2025 Sep;22(9):1361-1371. doi: 10.1513/AnnalsATS.202408-825OC.
Delayed (>5 minutes) epinephrine during pediatric in-hospital cardiac arrest (IHCA) is associated with worse outcomes. Epinephrine is nearly always given earlier, limiting 5 minutes as a quality target. To assess early epinephrine administration (⩽2 minutes) on outcomes and hemodynamics during cardiopulmonary resuscitation (CPR) in pediatric IHCA from pulseless, nonshockable rhythms. This study leveraged the database of the ICU-RESUS (Intensive Care Unit Resuscitation) project (clinicaltrials.gov identifier NCT02837497). Primary exposure was the time to epinephrine bolus: early versus >2 minutes. Primary outcome was survival to discharge. Secondary outcomes included the return of spontaneous circulation (ROSC), survival with favorable neurologic outcome, change from baseline to discharge Functional Status Scale (FSS) score, total FSS score at discharge, new morbidity among survivors, and invasively measured blood pressure during the first 10 minutes of CPR. Among 352 CPR events, median age was 1.0 (interquartile range [IQR], 0.3-8.0) year, 186 (53%) were male, and 185 (52.6%) had cardiac disease. Early epinephrine was administered in 273 (78%), and median time to administration was 1.0 (0.0-2.0) minute. Survival to discharge was similar between patients who received early epinephrine and those who did not. Early epinephrine administration was associated with higher ROSC, a change from baseline to discharge in FSS, lower total FSS scores at discharge, and lower rates of new morbidity compared with epinephrine administration at >2 minutes. The probability of ROSC and survival to discharge with favorable neurologic outcome decreased for each minute of delay in epinephrine administration. There was no difference in the invasive blood pressure targets during the first 10 minutes of CPR. Early epinephrine administration was common and was associated with higher ROSC and improved functional outcomes compared with epinephrine administration at >2 minutes in pediatric IHCA.
小儿院内心脏骤停（IHCA）期间延迟（>5分钟）使用肾上腺素与更差的预后相关。肾上腺素几乎总是更早给予，将5分钟作为质量目标。为评估小儿IHCA中无脉性、不可电击心律的心肺复苏（CPR）期间早期（≤2分钟）给予肾上腺素对预后和血流动力学的影响。本研究利用了ICU - RESUS（重症监护病房复苏）项目的数据库（临床试验.gov标识符NCT02837497）。主要暴露因素是给予肾上腺素推注的时间：早期与>2分钟。主要结局是出院存活。次要结局包括自主循环恢复（ROSC）、伴有良好神经功能结局的存活、从基线到出院的功能状态量表（FSS）评分变化、出院时的总FSS评分、幸存者中的新发疾病以及CPR前10分钟内有创测量的血压。在352次CPR事件中，中位年龄为1.0（四分位间距[IQR]，0.3 - 8.0）岁，186例（53%）为男性，185例（52.6%）患有心脏病。273例（78%）给予了早期肾上腺素，中位给药时间为1.0（0.0 - 2.0）分钟。接受早期肾上腺素治疗的患者与未接受者的出院存活率相似。与>2分钟给予肾上腺素相比，早期给予肾上腺素与更高的ROSC、从基线到出院的FSS变化、出院时更低的总FSS评分以及更低的新发疾病发生率相关。肾上腺素给药每延迟一分钟，ROSC以及伴有良好神经功能结局出院存活的概率都会降低。CPR前10分钟内有创血压目标并无差异。在小儿IHCA中，早期给予肾上腺素很常见，与>2分钟给予肾上腺素相比，其与更高的ROSC和改善的功能结局相关。
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