Sudden cardiac arrest is a primary cause of death in adults (about 300,000 deaths each year in the United States), but it's actually quite rare in the young. That said, approximately 16,000 pediatric patients suffer cardiac arrest each year in the U.S.
Younger patients, specifically younger than 1 year of age, comprise the majority of pediatric patients with cardiac arrest, and males are affected in a slightly higher proportion (62 percent).
A collective review of pediatric cases of cardiac arrest published a decade ago reported a survival rate to discharge of 13 percent, with good neurologic outcome in 62 percent of these patients. This early study identified that patients who sustain a cardiac arrest (CA) in the hospital setting have better survival as compared to patients with CA out of the hospital (24 vs. 8.4 percent, respectively).
Delay in administration of the first epinephrine dose is associated with decreased survival among adults after in-hospital, nonshockable cardiac arrest. Whether this association is true in the pediatric in-hospital cardiac arrest population remained unknown, so researchers set out to determine the answer by analyzing data from the American Heart Association's "Get with the Guidelines-Resuscitation" registry (GWTG-R). The results were published recently in the Journal of the American Medical Association.
In the study, time to epinephrine was defined as time in minutes from recognition of loss of pulse to the first dose of epinephrine. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC), survival at 24 hours and neurological outcome.
A favorable neurological outcome was defined as a score of 1 to 2 on the Pediatric Cerebral Performance Category scale. Researchers included U.S. pediatric patients with an in-hospital cardiac arrest and an initial nonshockable rhythm who received at least one dose of epinephrine. A total of 1,558 patients (median age of nine months) were included in the final cohort. Among the 1,558 patients, 487 (31.3 percent) survived to hospital discharge.
The median time to first epinephrine dose was 1 minute. Longer time to epinephrine administration was associated with lower risk of survival to discharge in multivariable analysis. Longer time to epinephrine administration was also associated with decreased risk of ROSC, decreased risk of survival at 24 hours, and decreased risk of survival with favorable neurological outcome.
Patients with time to epinephrine administration of longer than 5 minutes (233 of the 1,558) compared with those with time to epinephrine of 5 minutes or less (1325 of the 1,558) had lower risk of in-hospital survival to discharge (21.0 vs. 33.1 percent, respectively).
Basically, each minute of delay cut survival chance by 5 percent.
Among children with in-hospital cardiac arrest with an initial nonshockable rhythm who received epinephrine, the researchers found a delay in administration of epinephrine was associated with the decreased chance of survival to hospital discharge, ROSC, 24-hour survival and survival to hospital discharge with a favorable neurological outcome.
