Weight-Based Versus Flat Dosing of Epinephrine During Cardiac Arrest in the Pediatric Intensive Care Unit: A Multi-Center Survey

• Type of Material: Article
• Authors: Vijay Srinivasan, University of Pennsylvania; Ken Tegtmeyer, University of Cincinnati; Robert M Sutton, University of Pennsylvania; Heather A Wolfe, University of Pennsylvania; Martha F Kienzle, University of Pennsylvania; Ryan W Morgan, University of Pennsylvania; Maya Dewan, University of Cincinnati; Kiran Hebbar, Emory University; Vinay M Nadkarni, University of Pennsylvania
• Language: English
• Date: 2022-06-08
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
• Final Published Version (URL): https://doi.org/10.1097%2FPCC.0000000000003012
• Title of Journal or Parent Work: Pediatric Critical Care Medicine
• Volume: 23
• Issue: 10
• Start Page: e451
• End Page: e455
• Grant/Funding Information: Dr. Sutton’s institution received funding from an NIH grant. Dr. Wolfe received funding from Debriefing Academy and Zoll Medical.; Dr. Morgan’s institution received funding from the National Heart, Lung, and Blood Institute (K23HL148541).; Drs. Morgan and Dewan received support for article research from the National Institutes of Health (NIH).
• Keywords: cardiopulmonary resuscitation; epinephrine; cardiac arrest; survey; children
• Research Categories: Health Sciences, Pharmacology; Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

Objectives: Pediatric Advanced Life Support (PALS) guidelines include weight-based epinephrine dosing recommendations of 0.01 mg/kg with a maximum of 1mg, which corresponds to a weight of 100kg. Actual practice patterns are unknown. Design: Multi-center cross-sectional survey regarding institutional practices for the transition from weight-based to flat dosing of epinephrine during cardiopulmonary resuscitation in pediatric intensive care units (PICUs). Exploratory analyses compared epinephrine dosing practices with several institutional characteristics using Fisher’s exact test. Setting: Internet-based survey. Subjects: U.S. PICU representatives (one per institution) involved in resuscitation systems of care. Interventions: None. Measurements and main results: Of 137 institutions surveyed, 68 (50%) responded. Most responding institutions are freestanding children’s hospitals or dedicated children’s hospitals within combined adult/pediatric hospitals (67; 99%); 55 (81%) are academic and 41 (60%) have PICU fellowship programs. Among respondents, institutional roles include PICU medical director (13; 19%), resuscitation committee member (23; 34%) and attending physician with interest in resuscitation (21; 31%). When choosing between weight-based and flat dosing, 64 (94%) respondents report using patient weight, 23 (34%) patient age and 5 (7%) patient pubertal stage. Among those reporting using weight, 28 (44%) switch at 50 to <60kg, 17 (27%) at 60 to <80kg, 5 (8%) at 80 to <100kg and 8 (12%) at ≥100kg. Among those reporting using age, 4 (17%) switch at 14 to <16 years, 5 (22%) at 16 to <18 and 6 (26%) at ≥18. Twenty-nine (43%) respondents report using ideal body weight when dosing epinephrine in obese patients. Using patient age in choosing epinephrine dosing is more common in institutions that require ACLS certification for some/all code team responders compared to institutions that do not require ACLS certification (52% vs 22%, p = 0.02). Conclusions: The majority of PICUs surveyed report epinephrine dosing practices that are inconsistent with PALS guidelines.