Peri-arrest bolus epinephrine practices amongst pediatric resuscitation experts.
Peri-arrest bolus epinephrine practices amongst pediatric resuscitation experts.
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DOI：
10.1016/j.resplu.2021.100200
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发表时间：
2022-03
影响因子：
2.4
通讯作者：
Sullivan AM
中科院分区：
文献类型：
--
作者：
Ross CE;Hayes MM;Kleinman ME;Donnino MW;Sullivan AM
在一项跨国调查中，描述目前儿科复苏专家在停搏期注射肾上腺素的做法。一份包含9个问题的调查被开发出来，并以电子方式分发给儿科重症监护医生，他们是儿科复苏质量协作（pediRES-Q）网络的现场调查员。机构人口统计数据是通过美国医院协会2018年年度调查收集的，并与回应相关联。描述性统计用于描述封闭式回答，定性内容分析用于分析开放式回答。在受邀参与的63个合作成员中，49个（78%）做出了回应，代表了9个国家的35个机构。49个应答者中有46个（94%）报告说，他们会考虑在不需要心肺复苏的危重情况下使用停搏期大剂量肾上腺素。初始剂量策略从0.1微克/千克到10微克/千克不等，在回答这个问题的37名应答者中，有25人（68%）最常报告的初始剂量为1微克/千克。49名参与者中有3名（6%）表示，他们通常会避免使用停搏期肾上腺素，理由是缺乏支持其使用的证据。在这项针对儿科复苏专家的跨国调查中，尽管一些临床医生认为缺乏证据支持这种做法，但对停搏期注射肾上腺素的支持几乎是普遍的。报告的初始以体重为基础的剂量范围有100倍的差异，少数临床医生报告使用非以体重为基础的剂量。需要进一步的研究来确定最佳做法、初始剂量的标准化、可能需要调整剂量的临床因素以及与临床重要结果的关联。
To describe current practices of peri-arrest bolus epinephrine use amongst pediatric resuscitation experts in a multinational survey. A 9-question survey was developed and electronically distributed to pediatric critical care physicians who are site investigators for the Pediatric Resuscitation Quality Collaborative (pediRES-Q) network. Institutional demographics were collected through the American Hospital Association 2018 Annual Survey and linked to responses. Descriptive statistics were used to characterize closed-ended responses, and qualitative content analysis to analyze open-ended responses. Of the 63 collaborative members invited to participate, 49 (78%) responded, representing 35 institutions in 9 countries. Forty-six of the 49 respondents (94%) reported that they would consider using peri-arrest bolus epinephrine during critical situations in patients not requiring cardiopulmonary resuscitation. Initial dosing strategies ranged from 0.1mcg/kg to 10mcg/kg, with the most commonly reported initial dose of 1mcg/kg by 25 of the 37 (68%) respondents who answered this question. Three of the 49 (6%) participants indicated that they would generally avoid using peri-arrest bolus epinephrine, citing lack of evidence to support its use. In this multinational survey of pediatric resuscitation experts, endorsement of peri-arrest bolus epinephrine use was nearly universal, though a few clinicians cited lack of evidence to support this practice. There was a 100-fold difference in the range of initial weight-based doses reported, as well as a minority of clinicians who reported using non-weight-based dosing. Further research is needed to determine best practices, standardization of initial dosing, clinical factors that may warrant dosing modifications and associations with clinically important outcomes.
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