Evidence map›Paper›PMID 39010134›Full record

Trial reportCritical care (London, England)2024

Early bolus epinephrine administration during pediatric cardiopulmonary resuscitation for bradycardia with poor perfusion: an ICU-resuscitation study.

Amanda J O'Halloran, Ron W Reeder, Robert A Berg, Tageldin Ahmed, Michael J Bell, Robert Bishop, Matthew Bochkoris, Candice Burns, Joseph A Carcillo, Todd C Carpenter and 37 more

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

47 authors.

Amanda J O'HalloranDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA. ohallorana@chop.edu.
Ron W ReederDepartment of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Robert A BergDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Tageldin AhmedDepartment of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
Michael J BellDepartment of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, D.C., DC, USA.
Robert BishopDepartment of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
Matthew BochkorisDepartment of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Candice BurnsDepartment of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
Joseph A CarcilloDepartment of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Todd C CarpenterDepartment of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
J Michael DeanDepartment of Pediatrics, University of Utah, Salt Lake City, UT, USA.
J Wesley DiddleDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Myke FedermanDepartment of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
Richard FernandezDepartment of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Ericka L FinkDepartment of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Deborah FranzonDepartment of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
Aisha H FrazierNemours Cardiac Center, Nemours Children's Health, Wilmington, DE, USA.
Stuart H FriessDepartment of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
Kathryn GrahamDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Mark HallDepartment of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
David A HehirDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Christopher M HorvatDepartment of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Leanna L HuardDepartment of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
Martha F KienzleDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Todd J KilbaughDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Tensing MaaDepartment of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Arushi MangaDepartment of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
Patrick S McQuillenDepartment of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
Kathleen L MeertDepartment of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
Peter M MouraniDepartment of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
Vinay M NadkarniDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Maryam Y NaimDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Daniel NottermanDepartment of Molecular Biology, Princeton University, Princeton, NJ, USA.
Murray M PollackDepartment of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, D.C., DC, USA.
Anil SapruDepartment of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
Carleen SchneiterDepartment of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
Matthew P SharronDepartment of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, D.C., DC, USA.
Neeraj SrivastavaDepartment of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
Bradley TilfordDepartment of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
Alexis A TopjianDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Shirley ViteriDepartment of Pediatrics, Nemours/Alfred I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE, USA.
David WesselDepartment of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, D.C., DC, USA.
Heather A WolfeDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Andrew R YatesDepartment of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Athena F ZuppaDepartment of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Robert M Sutton *Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Ryan W Morgan *Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.

Funding

Data Coordinating Center for the Collaborative Pediatric Critical Care Research NetworkU01HD049934 · NICHD · UNIVERSITY OF UTAH · PI DEAN, JONATHAN MICHAEL · 2005 to 2020
$35.2M
CPCCRN PRECISE SupplementPL1HD105462 · NICHD · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · PI Kevin M Watt · 2021 to 2026
$17.5M
Improving Outcomes after Pediatric Cardiac ArrestR01HL131544 · NHLBI · CHILDREN'S HOSP OF PHILADELPHIA · PI SUTTON, ROBERT MICHAEL · 2016 to 2020
$3.9M
Collaborative Pediatric Critical Care Research Network (CPCCRN) at Children's NationalUG1HD049981 · NICHD · CHILDREN'S RESEARCH INSTITUTE · PI POLLACK, MURRAY MICHAEL, WESSEL, DAVID LLOYD · 2015 to 2020
$1.8M
Pediatric Critical Care Research Network at Children's Hospital of PhiladelphiaUG1HD063108 · NICHD · CHILDREN'S HOSP OF PHILADELPHIA · PI BERG, ROBERT ALLEN, ZUPPA, ATHENA F. · 2015 to 2020
$1.7M
Collaborative Research to Validate Biomarkers of Pediatric ARDSUG1HD083166 · NICHD · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MCQUILLEN, PATRICK SEAN, SAPRU, ANIL · 2015 to 2020
$1.6M
Renewal Application for the Childrens Hospital of Pittsburgh Collaborative Pediatric Critical Care Research Network SiteUG1HD049983 · NICHD · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI CARCILLO, JOSEPH A · 2015 to 2020
$1.6M
Collaborative Pediatric Critical Care Research NetworkUG1HD050096 · NICHD · WAYNE STATE UNIVERSITY · PI MEERT, KATHLEEN L. · 2015 to 2020
$1.6M
Collaborative Network Study of Airway Microbiome and Host Responses in Pediatric Respiratory FailureUG1HD083171 · NICHD · UNIVERSITY OF COLORADO DENVER · PI CARPENTER, TODD C · 2015 to 2020
$1.5M
Collaborative Pediatric Critical Care Research Network (UG1)UG1HD083170 · NICHD · RESEARCH INST NATIONWIDE CHILDREN'S HOSP · PI HALL, MARK W · 2015 to 2020
$1.5M
Validation of Physiologic CPR Quality Using NOn-inVasive Waveform Analytics (CPR-NOVA)R01HL147616 · NHLBI · CHILDREN'S HOSP OF PHILADELPHIA · PI BERG, ROBERT ALLEN, SUTTON, ROBERT MICHAEL · 2019 to 2021
$1.2M
Pulmonary Hypertension-Associated Pediatric Cardiac ArrestK23HL148541 · NHLBI · CHILDREN'S HOSP OF PHILADELPHIA · PI MORGAN, RYAN WILLIAM · 2020 to 2024
$791k
National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development U01HD049934National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development UG1HD049981National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development UG1HD049983National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development UG1HD050096National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development UG1HD063108National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development UG1HD083166National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development UG1HD083170National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development UG1HD083171NHLBI NIH HHS K23 HL148541NHLBI NIH HHS K23HL148541NHLBI NIH HHS R01HL131544NHLBI NIH HHS R01HL147616NICHD NIH HHS PL1 HD105462NICHD NIH HHS UG1 HD083171
6 · The paper itself

Abstract

backgroundHalf of pediatric in-hospital cardiopulmonary resuscitation (CPR) events have an initial rhythm of non-pulseless bradycardia with poor perfusion. Our study objectives were to leverage granular data from the ICU-RESUScitation (ICU-RESUS) trial to: (1) determine the association of early epinephrine administration with survival outcomes in children receiving CPR for bradycardia with poor perfusion; and (2) describe the incidence and time course of the development of pulselessness.

methodsPrespecified secondary analysis of ICU-RESUS, a multicenter cluster randomized trial of children (< 19 years) receiving CPR in 18 intensive care units in the United States. Index events (October 2016-March 2021) lasting ≥ 2 min with a documented initial rhythm of bradycardia with poor perfusion were included. Associations between early epinephrine (first 2 min of CPR) and outcomes were evaluated with Poisson multivariable regression controlling for a priori pre-arrest characteristics. Among patients with arterial lines, intra-arrest blood pressure waveforms were reviewed to determine presence of a pulse during CPR interruptions. The temporal nature of progression to pulselessness was described and outcomes were compared between patients according to subsequent pulselessness status.

resultsOf 452 eligible subjects, 322 (71%) received early epinephrine. The early epinephrine group had higher pre-arrest severity of illness and vasoactive-inotrope scores. Early epinephrine was not associated with survival to discharge (aRR 0.97, 95%CI 0.82, 1.14) or survival with favorable neurologic outcome (aRR 0.99, 95%CI 0.82, 1.18). Among 186 patients with invasive blood pressure waveforms, 118 (63%) had at least 1 period of pulselessness during the first 10 min of CPR; 86 (46%) by 2 min and 100 (54%) by 3 min. Sustained return of spontaneous circulation was highest after bradycardia with poor perfusion (84%) compared to bradycardia with poor perfusion progressing to pulselessness (43%) and bradycardia with poor perfusion progressing to pulselessness followed by return to bradycardia with poor perfusion (62%) (p < 0.001).

conclusionsIn this cohort of pediatric CPR events with an initial rhythm of bradycardia with poor perfusion, we failed to identify an association between early bolus epinephrine and outcomes when controlling for illness severity. Most children receiving CPR for bradycardia with poor perfusion developed subsequent pulselessness, 46% within 2 min of CPR onset.

Indexed as

BradycardiaCardiopulmonary ResuscitationEpinephrineAdolescentChildChild, PreschoolFemaleHumansInfantIntensive Care UnitsMaleEpinephrineBradycardiaCardiopulmonary resuscitationEpinephrineHeart arrestHemodynamicsPediatric intensive care units

Identifiers

PMID39010134
PMCPMC11251231

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.