The physiologic response to epinephrine and pediatric cardiopulmonary resuscitation outcomes

作者：Ryan W. Morgan, Robert Allen Berg, Ron Reeder, Todd C. Carpenter, Deborah Franzon, Aisha H. Frazier, Kathryn Graham, Kathleen L. Meert, Vinay Nadkarni, Maryam Y. Naim, Bradley Tilford, Heather A Wolfe, Andrew R. Yates, Robert Michael Sutton, Tageldin Ahmed, Michael J. Bell, Robert J. Bishop, Matthew Bochkoris, Candice Burns, Joseph A. Carcillo, Jay B. Dean, John Wesley Diddle, Myke Federman, Richard P. Fernandez, Ericka L. Fink, Stuart Howard Friess, Mark Hall, David A. Hehir, Christopher M. Horvat, Leanna L. Huard, Tensing Maa, Arushi Manga, Patrick S. McQuillen, Peter M. Mourani, Daniel A. Notterman, Murray M. Pollack, Anil Sapru, Carleen Schneiter, Matthew P. Sharron, Neeraj Srivastava, Sarah Tabbutt, Shirley Viteri, DAVID L. WESSEL, Andrew R. Yates, Athena F. Zuppa · 发表于：Critical Care · 年份：2023 · DOI：10.1186/s13054-023-04399-5 · 被引用次数：42 · 研究领域：Cardiac Arrest and Resuscitation、Sepsis Diagnosis and Treatment、Mechanical Circulatory Support Devices

BACKGROUND: Epinephrine is provided during cardiopulmonary resuscitation (CPR) to increase systemic vascular resistance and generate higher diastolic blood pressure (DBP) to improve coronary perfusion and attain return of spontaneous circulation (ROSC). The DBP response to epinephrine during pediatric CPR and its association with outcomes have not been well described. Thus, the objective of this study was to measure the association between change in DBP after epinephrine administration during CPR and ROSC. METHODS: This was a prospective multicenter study of children receiving ≥ 1 min of CPR with ≥ 1 dose of epinephrine and evaluable invasive arterial BP data in the 18 ICUs of the ICU-RESUS trial (NCT02837497). Blood pressure waveforms underwent compression-by-compression quantitative analysis. The mean DBP before first epinephrine dose was compared to mean DBP two minutes post-epinephrine. Patients with ≥ 5 mmHg increase in DBP were characterized as "responders." RESULTS: Among 147 patients meeting inclusion criteria, 66 (45%) were characterized as responders and 81 (55%) were non-responders. The mean increase in DBP with epinephrine was 4.4 [- 1.9, 11.5] mmHg (responders: 13.6 [7.5, 29.3] mmHg versus non-responders: - 1.5 [- 5.0, 1.5] mmHg; p < 0.001). After controlling for a priori selected covariates, epinephrine response was associated with ROSC (aRR 1.60 [1.21, 2.12]; p = 0.001). Sensitivity analyses identified similar associations between DBP response thresholds of ≥ 1...