Pediatric research · 2025
Comparison of vasopressin to epinephrine during pediatric in-hospital cardiac arrest: survival and physiologic responsiveness.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Loaec Morgann, Keim Garrett, Graham Kathryn, Kienzle Martha F, O'Halloran Amanda, Shepard Lindsay N, Mehta Sanjiv, Sawhney Samridhi, Donoghue Marion, Cooper Kellimarie, Kilbaugh Todd J, Nadkarni Vinay, Topjian Alexis A, Berg Robert A, Sutton Robert M, Morgan Ryan W
Аннотация
AIM: To compare post-epinephrine vasopressin administration versus epinephrine and time to return of spontaneous circulation (ROSC) during pediatric in-hospital cardiac arrest (IHCA), and explore vasopressin's physiologic effects.
METHODS: This single-center, retrospective cohort study (2017-2023) compared vasopressin patients who received ≥1 dose of preceding epinephrine and matched epinephrine-only patients based on age, illness category, and preceding epinephrine dosing. Time to ROSC was analyzed using Cox regression. Vasopressor response was defined as ≥5 mmHg increase in diastolic blood pressure (DBP).
RESULTS: Forty-one matched pairs were analyzed. Median CPR duration was 36.5 [IQR 23, 48] minutes; median time to dose was 14.5 [10.8, 19] minutes. ROSC occurred in 10/41 (24%) vasopressin and 15/41 (36%) epinephrine patients (p = 0.34) with no difference in time to ROSC (aHR 0.73 [95% CI: 0.31-1.7]). Vasopressor response occurred in 4/12 (33%) vasopressin and 1/7 (14%) epinephrine patients (p = 0.60). Regression discontinuity analysis demonstrated a change in DBP of +2.3 mmHg after vasopressin (95% CI: -11.4, 16.0) and -5.67 mmHg after epinephrine (-15.13, 3.80).
CONCLUSION: No significant differences were found in time to ROSC or DBP increase between vasopressin and epinephrine given late during CPR. A subset of vasopressin responders suggests further research on intra-arrest DBP response to vasopressin is needed.
IMPACT: The use of intra-arrest vasopressin is an understudied topic in pediatric cardiac arrest. This study presents a unique comparison of ongoing epinephrine to vasopressin administration, using dose matching to address the limitations of our current vasopressin use. We present a novel analysis of physiologic response to vasopressin using the change in diastolic blood pressure.
METHODS: This single-center, retrospective cohort study (2017-2023) compared vasopressin patients who received ≥1 dose of preceding epinephrine and matched epinephrine-only patients based on age, illness category, and preceding epinephrine dosing. Time to ROSC was analyzed using Cox regression. Vasopressor response was defined as ≥5 mmHg increase in diastolic blood pressure (DBP).
RESULTS: Forty-one matched pairs were analyzed. Median CPR duration was 36.5 [IQR 23, 48] minutes; median time to dose was 14.5 [10.8, 19] minutes. ROSC occurred in 10/41 (24%) vasopressin and 15/41 (36%) epinephrine patients (p = 0.34) with no difference in time to ROSC (aHR 0.73 [95% CI: 0.31-1.7]). Vasopressor response occurred in 4/12 (33%) vasopressin and 1/7 (14%) epinephrine patients (p = 0.60). Regression discontinuity analysis demonstrated a change in DBP of +2.3 mmHg after vasopressin (95% CI: -11.4, 16.0) and -5.67 mmHg after epinephrine (-15.13, 3.80).
CONCLUSION: No significant differences were found in time to ROSC or DBP increase between vasopressin and epinephrine given late during CPR. A subset of vasopressin responders suggests further research on intra-arrest DBP response to vasopressin is needed.
IMPACT: The use of intra-arrest vasopressin is an understudied topic in pediatric cardiac arrest. This study presents a unique comparison of ongoing epinephrine to vasopressin administration, using dose matching to address the limitations of our current vasopressin use. We present a novel analysis of physiologic response to vasopressin using the change in diastolic blood pressure.