Epinephrine in pediatric cardiorespiratory arrest: when and how much?

ABSTRACT The objective of the present study was to assess the efficacy of different doses, times for infusion of the first dose, intervals of administration of subsequent doses, and number of epinephrine doses in the survival of children and adolescents who went into cardiorespiratory arrest. It is a review study with data from the PubMedⓇ/MEDLINEⓇdatabase. The search was for articles published from January 1st, 2000 to February 10, 2019, with a sample of patients aged under 18 years, published in English, Portuguese and Spanish. We found 222 articles, of which 16 met the inclusion criteria of the study. The first dose should be given as soon as possible. The standard dose (0.01mg/kg) has a better outcome when compared to the higher dose (0.1mg/kg). There is an iⓇverse relation between the number of epinephrine doses and survival. The interval currently recommended between doses has lower survival when compared to larger intervals. The dosage recommended by the American Heart Association presents a better outcome for survival, but the interval between doses and the maximum number of doses should be better assessed.

摘要 本研究旨在评估不同给药剂量、首剂输注时机、后续给药间隔以及肾上腺素（epinephrine）给药次数对发生心搏骤停（cardiorespiratory arrest）的儿童及青少年生存率的影响。本研究为综述类研究，数据来源于PubMedⓇ/MEDLINEⓇ数据库。检索范围为2000年1月1日至2019年2月10日发表的、纳入18岁以下患者的英文、葡萄牙语及西班牙语文献。最终共检索到222篇文献，其中16篇符合本研究的纳入标准。研究结果显示，首剂应尽快给药；标准剂量（0.01mg/kg）相较于高剂量（0.1mg/kg）可获得更优的预后结局；肾上腺素给药次数与生存率呈负相关；当前推荐的给药间隔相较于更长给药间隔，会导致更低的生存率；美国心脏协会（American Heart Association）推荐的给药剂量可获得更优的生存结局，但给药间隔与最大给药次数仍需进一步优化评估。