Does Faster Time to Epinephrine Improve Outcomes in Pediatric Pulseless Arrest with Nonshockable Rhythm?

A study completed from 2000 to 2014 by Andersen and colleagues used 15,959 pediatric patients in-hospital cardiac arrests. 1,558 children (9.8%) received epinephrine in at least one dose for nonshockable rhythms during cardiopulmonary resuscitation (CPR). 50% of these children received the medication during the same or next minute after the pulse was lost. 15% received the medication after 5 minutes.

740 patients were excluded because they did not receive epinephrine, 363 patients were excluded for having rapid return of spontaneous circulation (ROSC) within 2 minutes. For a variety of reasons, this study was different from a randomized clinical trial, which would be nearly impossible to initiate in a pediatric hospital for this condition.

This study reinforced that overall, pediatric patients with in-hospital cardiac arrests and nonshockable rhythms have poor overall prognosis. Fewer than 33% of patients survive to discharge and many have poor neurocognitive outcomes. The results of the study proved that epinephrine should be given within the first 5 minutes after CPR, as currently recommended. Since many patients reached ROSC within the first 2 minutes without receiving the medication, it cannot be determined that outcomes are better within 2 minutes.

JAMA. 2015;314(8):776-777. 

This article is interesting and shows the importance of providing efficient and correct care. Patients rely on health care providers to think and work quickly. Since it is impossible to do a randomized clinical trial in this setting, research is difficult. I think that despite the lack of research, clinicians should diagnose and administer the medication as quickly as possible. I believe that this would improve patient outcomes by increasing survival and decreasing poor neurocognitive outcomes. How can a pharmacist help the interprofessional team to improve pediatric patient outcomes? Are the guidelines different for adult patients?