Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest

Tatsuma Fukuda, Yutaka Kondo, Kei Hayashida, Hiroshi Sekiguchi, Ichiro Kukita

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aims Delay in administration of epinephrine is associated with decreased survival among children with in-hospital cardiac arrest with an initial non-shockable rhythm. Whether this association is applicable to paediatric out-of-hospital cardiac arrest (OHCA) population remains unknown. We aimed to determine whether time to epinephrine administration is associated with outcomes in paediatric OHCA. Methods and results This was a nation-wide population-based study of paediatric OHCA in Japan from 2005 to 2012 based on data from the All-Japan Utstein Registry. We included paediatric OHCA patients (aged between 1 and 17 years) who received at least one dose of epinephrine. The primary outcome was 30-day survival. A total of 225 patients were included in the final cohort. Among the 225 patients, 23 (10.2%) survived 30 days after OHCA. The median time from emergency call to first epinephrine administration was 26 min [interquartile range, 20-32; range, 9-128; mean (standard deviation), 28.7 (15.5) min]. Longer time to epinephrine administration was associated with decreased chance of survival: 50.0, 41.2, 13.0, 11.6, 3.9, and 3.1%, respectively, when time to epinephrine was treated as a categorical variable categorized into <-10, 11-15, 16-20, 21-25, 26-30, or > 30 min (P for trend <0.0001), and adjusted odds ratio 0.90 (95% confidence interval 0.82-0.96, P = 0.0011) when time to epinephrine was treated as a linear and continuous variable in a multivariable logistic regression model. Similar trends were observed for prehospital return of spontaneous circulation (P = 0.0032) and neurologically favourable survival (P = 0.0014). Conclusions Among paediatric OHCA patients, delayed administration of epinephrine was associated with a decreased chance of favourable outcomes.

Original languageEnglish
Pages (from-to)144-151
Number of pages8
JournalEuropean Heart Journal - Cardiovascular Pharmacotherapy
Volume4
Issue number3
DOIs
Publication statusPublished - 2018 Jul 1

Fingerprint

Out-of-Hospital Cardiac Arrest
Pediatric Hospitals
Epinephrine
Survival
Japan
Logistic Models
Heart Arrest
Population
Registries
Emergencies
Odds Ratio
Confidence Intervals

Keywords

  • Cardiopulmonary resuscitation
  • Children
  • Epidemiology
  • Out-of-hospital cardiac arrest
  • Paediatrics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest. / Fukuda, Tatsuma; Kondo, Yutaka; Hayashida, Kei; Sekiguchi, Hiroshi; Kukita, Ichiro.

In: European Heart Journal - Cardiovascular Pharmacotherapy, Vol. 4, No. 3, 01.07.2018, p. 144-151.

Research output: Contribution to journalArticle

Fukuda, Tatsuma ; Kondo, Yutaka ; Hayashida, Kei ; Sekiguchi, Hiroshi ; Kukita, Ichiro. / Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest. In: European Heart Journal - Cardiovascular Pharmacotherapy. 2018 ; Vol. 4, No. 3. pp. 144-151.
@article{ee3ffea2f9c8435fb7a6a96aef7789fb,
title = "Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest",
abstract = "Aims Delay in administration of epinephrine is associated with decreased survival among children with in-hospital cardiac arrest with an initial non-shockable rhythm. Whether this association is applicable to paediatric out-of-hospital cardiac arrest (OHCA) population remains unknown. We aimed to determine whether time to epinephrine administration is associated with outcomes in paediatric OHCA. Methods and results This was a nation-wide population-based study of paediatric OHCA in Japan from 2005 to 2012 based on data from the All-Japan Utstein Registry. We included paediatric OHCA patients (aged between 1 and 17 years) who received at least one dose of epinephrine. The primary outcome was 30-day survival. A total of 225 patients were included in the final cohort. Among the 225 patients, 23 (10.2{\%}) survived 30 days after OHCA. The median time from emergency call to first epinephrine administration was 26 min [interquartile range, 20-32; range, 9-128; mean (standard deviation), 28.7 (15.5) min]. Longer time to epinephrine administration was associated with decreased chance of survival: 50.0, 41.2, 13.0, 11.6, 3.9, and 3.1{\%}, respectively, when time to epinephrine was treated as a categorical variable categorized into <-10, 11-15, 16-20, 21-25, 26-30, or > 30 min (P for trend <0.0001), and adjusted odds ratio 0.90 (95{\%} confidence interval 0.82-0.96, P = 0.0011) when time to epinephrine was treated as a linear and continuous variable in a multivariable logistic regression model. Similar trends were observed for prehospital return of spontaneous circulation (P = 0.0032) and neurologically favourable survival (P = 0.0014). Conclusions Among paediatric OHCA patients, delayed administration of epinephrine was associated with a decreased chance of favourable outcomes.",
keywords = "Cardiopulmonary resuscitation, Children, Epidemiology, Out-of-hospital cardiac arrest, Paediatrics",
author = "Tatsuma Fukuda and Yutaka Kondo and Kei Hayashida and Hiroshi Sekiguchi and Ichiro Kukita",
year = "2018",
month = "7",
day = "1",
doi = "10.1093/ehjcvp/pvx023",
language = "English",
volume = "4",
pages = "144--151",
journal = "European Heart Journal - Cardiovascular Pharmacotherapy",
issn = "2055-6837",
publisher = "Oxford University Press",
number = "3",

}

TY - JOUR

T1 - Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest

AU - Fukuda, Tatsuma

AU - Kondo, Yutaka

AU - Hayashida, Kei

AU - Sekiguchi, Hiroshi

AU - Kukita, Ichiro

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Aims Delay in administration of epinephrine is associated with decreased survival among children with in-hospital cardiac arrest with an initial non-shockable rhythm. Whether this association is applicable to paediatric out-of-hospital cardiac arrest (OHCA) population remains unknown. We aimed to determine whether time to epinephrine administration is associated with outcomes in paediatric OHCA. Methods and results This was a nation-wide population-based study of paediatric OHCA in Japan from 2005 to 2012 based on data from the All-Japan Utstein Registry. We included paediatric OHCA patients (aged between 1 and 17 years) who received at least one dose of epinephrine. The primary outcome was 30-day survival. A total of 225 patients were included in the final cohort. Among the 225 patients, 23 (10.2%) survived 30 days after OHCA. The median time from emergency call to first epinephrine administration was 26 min [interquartile range, 20-32; range, 9-128; mean (standard deviation), 28.7 (15.5) min]. Longer time to epinephrine administration was associated with decreased chance of survival: 50.0, 41.2, 13.0, 11.6, 3.9, and 3.1%, respectively, when time to epinephrine was treated as a categorical variable categorized into <-10, 11-15, 16-20, 21-25, 26-30, or > 30 min (P for trend <0.0001), and adjusted odds ratio 0.90 (95% confidence interval 0.82-0.96, P = 0.0011) when time to epinephrine was treated as a linear and continuous variable in a multivariable logistic regression model. Similar trends were observed for prehospital return of spontaneous circulation (P = 0.0032) and neurologically favourable survival (P = 0.0014). Conclusions Among paediatric OHCA patients, delayed administration of epinephrine was associated with a decreased chance of favourable outcomes.

AB - Aims Delay in administration of epinephrine is associated with decreased survival among children with in-hospital cardiac arrest with an initial non-shockable rhythm. Whether this association is applicable to paediatric out-of-hospital cardiac arrest (OHCA) population remains unknown. We aimed to determine whether time to epinephrine administration is associated with outcomes in paediatric OHCA. Methods and results This was a nation-wide population-based study of paediatric OHCA in Japan from 2005 to 2012 based on data from the All-Japan Utstein Registry. We included paediatric OHCA patients (aged between 1 and 17 years) who received at least one dose of epinephrine. The primary outcome was 30-day survival. A total of 225 patients were included in the final cohort. Among the 225 patients, 23 (10.2%) survived 30 days after OHCA. The median time from emergency call to first epinephrine administration was 26 min [interquartile range, 20-32; range, 9-128; mean (standard deviation), 28.7 (15.5) min]. Longer time to epinephrine administration was associated with decreased chance of survival: 50.0, 41.2, 13.0, 11.6, 3.9, and 3.1%, respectively, when time to epinephrine was treated as a categorical variable categorized into <-10, 11-15, 16-20, 21-25, 26-30, or > 30 min (P for trend <0.0001), and adjusted odds ratio 0.90 (95% confidence interval 0.82-0.96, P = 0.0011) when time to epinephrine was treated as a linear and continuous variable in a multivariable logistic regression model. Similar trends were observed for prehospital return of spontaneous circulation (P = 0.0032) and neurologically favourable survival (P = 0.0014). Conclusions Among paediatric OHCA patients, delayed administration of epinephrine was associated with a decreased chance of favourable outcomes.

KW - Cardiopulmonary resuscitation

KW - Children

KW - Epidemiology

KW - Out-of-hospital cardiac arrest

KW - Paediatrics

UR - http://www.scopus.com/inward/record.url?scp=85049346610&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049346610&partnerID=8YFLogxK

U2 - 10.1093/ehjcvp/pvx023

DO - 10.1093/ehjcvp/pvx023

M3 - Article

C2 - 29036580

AN - SCOPUS:85049346610

VL - 4

SP - 144

EP - 151

JO - European Heart Journal - Cardiovascular Pharmacotherapy

JF - European Heart Journal - Cardiovascular Pharmacotherapy

SN - 2055-6837

IS - 3

ER -