Epinephrine Dosing Use During Extracorporeal Cardiopulmonary Resuscitation : Single-Center Retrospective Cohort
Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies..
OBJECTIVES: During pediatric cardiac arrest, contemporary guidelines recommend dosing epinephrine at regular intervals, including in patients requiring extracorporeal membrane oxygenation (ECMO). The impact of epinephrine-induced vasoconstriction on systemic afterload and venoarterial ECMO support is not well-defined.
DESIGN: Nested retrospective observational study within a single center. The primary exposure was time from last dose of epinephrine to initiation of ECMO flow; secondary exposures included cumulative epinephrine dose and arrest time. Systemic afterload was assessed by mean arterial pressure and use of systemic vasodilator therapy; ECMO pump flow and Vasoactive-Inotrope Score (VIS) were used as measures of ECMO support. Clearance of lactate was followed post-cannulation as a marker of systemic perfusion.
SETTING: PICU and cardiac ICU in a quaternary-care center.
PATIENTS: Patients 0-18 years old who required ECMO cannulation during resuscitation over the 6 years, 2014-2020. Patients were excluded if ECMO was initiated before cardiac arrest or if the resuscitation record was incomplete.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: A total of 92 events in 87 patients, with 69 events having complete data for analysis. The median (interquartile range) of total epinephrine dosing was 65 mcg/kg (37-101 mcg/kg), with the last dose given 6 minutes (2-16 min) before the initiation of ECMO flows. Shorter interval between last epinephrine dose and ECMO initiation was associated with increased use of vasodilators within 6 hours of ECMO ( p = 0.05), but not with mean arterial pressure after 1 hour of support (estimate, -0.34; p = 0.06). No other associations were identified between epinephrine delivery and mean arterial blood pressure, vasodilator use, pump speed, VIS, or lactate clearance.
CONCLUSIONS: There is limited evidence to support the idea that regular dosing of epinephrine during cardiac arrest is associated with increased in afterload after ECMO cannulation. Additional studies are needed to validate findings against ECMO flows and clinically relevant outcomes.
| Errataetall: |
CommentIn: Pediatr Crit Care Med. 2023 Nov 1;24(11):975-978. - PMID 37916882 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
|---|---|
| Enthalten in: |
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies - 24(2023), 11 vom: 01. Nov., Seite e531-e539 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Kucher, Nicholas M [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
33X04XA5AT |
|---|
| Anmerkungen: |
Date Completed 03.11.2023 Date Revised 06.11.2023 published: Print-Electronic CommentIn: Pediatr Crit Care Med. 2023 Nov 1;24(11):975-978. - PMID 37916882 Citation Status MEDLINE |
|---|
| doi: |
10.1097/PCC.0000000000003323 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM359403948 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM359403948 | ||
| 003 | DE-627 | ||
| 005 | 20231226080809.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1097/PCC.0000000000003323 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1197.xml |
| 035 | |a (DE-627)NLM359403948 | ||
| 035 | |a (NLM)37439601 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Kucher, Nicholas M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Epinephrine Dosing Use During Extracorporeal Cardiopulmonary Resuscitation |b Single-Center Retrospective Cohort |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 03.11.2023 | ||
| 500 | |a Date Revised 06.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Pediatr Crit Care Med. 2023 Nov 1;24(11):975-978. - PMID 37916882 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. | ||
| 520 | |a OBJECTIVES: During pediatric cardiac arrest, contemporary guidelines recommend dosing epinephrine at regular intervals, including in patients requiring extracorporeal membrane oxygenation (ECMO). The impact of epinephrine-induced vasoconstriction on systemic afterload and venoarterial ECMO support is not well-defined | ||
| 520 | |a DESIGN: Nested retrospective observational study within a single center. The primary exposure was time from last dose of epinephrine to initiation of ECMO flow; secondary exposures included cumulative epinephrine dose and arrest time. Systemic afterload was assessed by mean arterial pressure and use of systemic vasodilator therapy; ECMO pump flow and Vasoactive-Inotrope Score (VIS) were used as measures of ECMO support. Clearance of lactate was followed post-cannulation as a marker of systemic perfusion | ||
| 520 | |a SETTING: PICU and cardiac ICU in a quaternary-care center | ||
| 520 | |a PATIENTS: Patients 0-18 years old who required ECMO cannulation during resuscitation over the 6 years, 2014-2020. Patients were excluded if ECMO was initiated before cardiac arrest or if the resuscitation record was incomplete | ||
| 520 | |a INTERVENTIONS: None | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: A total of 92 events in 87 patients, with 69 events having complete data for analysis. The median (interquartile range) of total epinephrine dosing was 65 mcg/kg (37-101 mcg/kg), with the last dose given 6 minutes (2-16 min) before the initiation of ECMO flows. Shorter interval between last epinephrine dose and ECMO initiation was associated with increased use of vasodilators within 6 hours of ECMO ( p = 0.05), but not with mean arterial pressure after 1 hour of support (estimate, -0.34; p = 0.06). No other associations were identified between epinephrine delivery and mean arterial blood pressure, vasodilator use, pump speed, VIS, or lactate clearance | ||
| 520 | |a CONCLUSIONS: There is limited evidence to support the idea that regular dosing of epinephrine during cardiac arrest is associated with increased in afterload after ECMO cannulation. Additional studies are needed to validate findings against ECMO flows and clinically relevant outcomes | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Epinephrine |2 NLM | |
| 650 | 7 | |a YKH834O4BH |2 NLM | |
| 650 | 7 | |a Vasodilator Agents |2 NLM | |
| 650 | 7 | |a Lactic Acid |2 NLM | |
| 650 | 7 | |a 33X04XA5AT |2 NLM | |
| 700 | 1 | |a Marquez, Alexandra M |e verfasserin |4 aut | |
| 700 | 1 | |a Guerguerian, Anne-Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Moga, Michael-Alice |e verfasserin |4 aut | |
| 700 | 1 | |a Vargas-Gutierrez, Mariella |e verfasserin |4 aut | |
| 700 | 1 | |a Todd, Mark |e verfasserin |4 aut | |
| 700 | 1 | |a Honjo, Osami |e verfasserin |4 aut | |
| 700 | 1 | |a Haller, Christoph |e verfasserin |4 aut | |
| 700 | 1 | |a Goco, Geraldine |e verfasserin |4 aut | |
| 700 | 1 | |a Floh, Alejandro A |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies |d 2000 |g 24(2023), 11 vom: 01. Nov., Seite e531-e539 |w (DE-627)NLM124299717 |x 1529-7535 |7 nnns |
| 773 | 1 | 8 | |g volume:24 |g year:2023 |g number:11 |g day:01 |g month:11 |g pages:e531-e539 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1097/PCC.0000000000003323 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 24 |j 2023 |e 11 |b 01 |c 11 |h e531-e539 | ||