Pediatrics · 2 h ago
Adrenaline Timing and Outcomes in Pediatric Out-of-Hospital Cardiac Arrest
A retrospective cohort study used a Japanese national registry to examine adrenaline timing in 259 children with witnessed out-of-hospital cardiac arrest. The analysis found no statistically clear association between administration timing and one-month survival or favorable neurologic outcome, with wide confidence intervals.
- No timing association was identified for either outcome.
- The cohort included 259 children in Japan.
- Confidence intervals were wide, especially for early administration.
Researchers conducted a multicenter retrospective cohort study using the Japanese Association for Acute Medicine OHCA registry. The analysis included 259 patients younger than 18 years with witnessed out-of-hospital cardiac arrest who received adrenaline between June 2014 and December 2020. Risk-set matching with time-dependent propensity scores was used to address resuscitation time bias. Outcomes were survival and favorable neurologic status at one month, defined as a Pediatric Cerebral Performance Category score of 1–3.
Patients were compared by intervals from first emergency medical services contact to initial adrenaline administration. For one-month survival, risk ratios versus patients still at risk ranged from 0.97 (95% CI, 0.30–3.12) for administration at 11–15 minutes to 2.94 (95% CI, 0.38–22.81) at 1–10 minutes. The study found no association between timing and either survival or favorable neurologic outcome.
The findings do not establish that timing has no effect: estimates were imprecise, particularly in the earliest group, which included 15 patients. The retrospective observational design and restriction to witnessed arrests in a Japanese registry also limit interpretation and generalizability. The results do not support changing resuscitation practice on their own.
In practice
For children with witnessed out-of-hospital cardiac arrest, this retrospective Japanese registry analysis did not identify an association between the timing of initial adrenaline administration and one-month survival or favorable neurologic outcome. The findings do not establish equivalence or show that timing is unimportant: the cohort included 259 patients, timing subgroups were small, and confidence intervals were wide. The observational design and setting limit causal interpretation and applicability; this study alone does not justify changing resuscitation practice.
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Pediatric Critical Care Medicine: Timing of the Adrenaline Administration in Witnessed Pediatric Out-of-Hospital Cardiac Arrest: Retrospective, National Cohort Study in Japan, Using a 2014–2020 Dataset ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.