Early versus late administration of adrenaline in pediatric patients with out-of-hospital cardiac arrest

Objectives: Optimal timing of adrenaline administration in pediatric out-of-hospital cardiac arrest (OHCA) is unclear. We aimed to evaluate the impact of early versus late adrenaline administration on survival and neurological outcomes at one month in children experiencing OHCA with non-shockable rhythm.

Methods: This study is retrospective cohort study. Here we utilized the Japanese Association for Acute Medicine OHCA registry, focusing on children under 18 years who received adrenaline during non-shockable rhythm cardiac arrest. We performed a risk-set matching analysis with a time-dependent propensity score to address resuscitation time bias. We categorized adrenaline administration as early (within 20 min of emergency medical service personnel contact) or late (after 20 min). We set our primary and secondary outcomes as survival and favorable neurological outcomes at one month after cardiac arrest, respectively.

Results: Of the 701 eligible patients, 300 received adrenaline early. Early versus late adrenaline administration in the risk-set matched cohort of 600 patients did not yield significant differences in survival (risk ratio [RR] 0.98 [95% confidence interval (CI) 0.95-1.01]) or favorable neurological outcome (RR 1.00 [95% CI 0.99-1.00]) at one month. However, in a subgroup analysis of patients with witnessed cardiac arrest, early adrenaline administration appeared to be associated with improved one month survival (RR 0.91 [95% CI 0.85-0.98]).

Conclusions: Early adrenaline administration in pediatric OHCA was not associated with overall one month survival or neurologic outcome.