Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025
Comparison of the Efficacy of Epinephrine vs Norepinephrine in Clinical Outcomes among Children with Postcardiac Arrest Shock: A Hospital-based, Double Blind, Randomized Controlled Trial.
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Prasad Arun, Ghorui Arnab, Kumar Pradeep, Halder Pritam
Аннотация
BACKGROUND AND AIMS: Postcardiac arrest shock in pediatric patients poses significant clinical challenges due to high morbidity and mortality rates. Despite advancements in resuscitation techniques, managing postcardiac arrest syndrome remains complex. Traditionally, epinephrine has been used for postresuscitation shock, but recent studies suggest potential adverse effects. Norepinephrine, commonly used in adults, may offer advantages but lacks sufficient evidence in pediatric populations. This study aims to compare the efficacy and safety of norepinephrine vs epinephrine in children experiencing postcardiac arrest shock.
METHODOLOGY: This single-center, double blind, randomized controlled trial (RCT) will be conducted at a tertiary care hospital in India. It will include children aged 1 month to 18 years who experience cardiac arrest from noncardiac causes, achieve return of spontaneous circulation (ROSC), and develop postresuscitation shock. Patients with known cardiac diseases will be excluded. Participants will be randomized to receive either norepinephrine or epinephrine infusions. The primary outcome is in-hospital mortality. Secondary outcomes include duration of vasopressor use, mean arterial pressure (MAP) response, neurological outcomes [cerebral performance category (CPC) scale], and incidence of arrhythmias.
RESULTS: For analysis, categorical variables will be compared using the Chi-square test or Fisher's exact test, while continuous variables will be analyzed using either the independent Student's t-test or the Mann-Whitney U test, as appropriate.
CONCLUSION: This study will provide critical evidence on the comparative efficacy and safety of norepinephrine and epinephrine in pediatric postcardiac arrest shock, addressing a significant knowledge gap in pediatric critical care.
TRIAL REGISTRATION NUMBER: Clinical-Trials-Registry-India, Ref. No. CTRI/2025/03/081706 dated 5th March, 2025. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTE0NzM0&Enc=&userName=.
HOW TO CITE THIS ARTICLE: Prasad A, Ghorui A, Kumar P, Halder P. Comparison of the Efficacy of Epinephrine vs Norepinephrine in Clinical Outcomes among Children with Postcardiac Arrest Shock: A Hospital-based, Double Blind, Randomized Controlled Trial. Indian J Crit Care Med 2025;29(10):868-873.
METHODOLOGY: This single-center, double blind, randomized controlled trial (RCT) will be conducted at a tertiary care hospital in India. It will include children aged 1 month to 18 years who experience cardiac arrest from noncardiac causes, achieve return of spontaneous circulation (ROSC), and develop postresuscitation shock. Patients with known cardiac diseases will be excluded. Participants will be randomized to receive either norepinephrine or epinephrine infusions. The primary outcome is in-hospital mortality. Secondary outcomes include duration of vasopressor use, mean arterial pressure (MAP) response, neurological outcomes [cerebral performance category (CPC) scale], and incidence of arrhythmias.
RESULTS: For analysis, categorical variables will be compared using the Chi-square test or Fisher's exact test, while continuous variables will be analyzed using either the independent Student's t-test or the Mann-Whitney U test, as appropriate.
CONCLUSION: This study will provide critical evidence on the comparative efficacy and safety of norepinephrine and epinephrine in pediatric postcardiac arrest shock, addressing a significant knowledge gap in pediatric critical care.
TRIAL REGISTRATION NUMBER: Clinical-Trials-Registry-India, Ref. No. CTRI/2025/03/081706 dated 5th March, 2025. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTE0NzM0&Enc=&userName=.
HOW TO CITE THIS ARTICLE: Prasad A, Ghorui A, Kumar P, Halder P. Comparison of the Efficacy of Epinephrine vs Norepinephrine in Clinical Outcomes among Children with Postcardiac Arrest Shock: A Hospital-based, Double Blind, Randomized Controlled Trial. Indian J Crit Care Med 2025;29(10):868-873.