Trends over time in drug administration during pediatric in-hospital cardiac arrest in the United States

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  • Catherine E Ross, Boston Children's Hospital and Harvard Medical School
  • ,
  • Ari Moskowitz, Beth Israel Deaconess Medical Center and Harvard Medical School
  • ,
  • Anne V Grossestreuer, Beth Israel Deaconess Medical Center and Harvard Medical School
  • ,
  • Mathias J Holmberg
  • Lars W Andersen
  • Tuyen T Yankama, Beth Israel Deaconess Medical Center and Harvard Medical School
  • ,
  • Robert A Berg
  • ,
  • Amanda O'Halloran
  • ,
  • Monica E Kleinman, Boston Children's Hospital and Harvard Medical School
  • ,
  • Michael W Donnino, Beth Israel Deaconess Medical Center and Harvard Medical School
  • ,
  • American Heart Association’s Get With The Guidelines – Resuscitation Investigators

AIMS: To describe trends in pediatric in-hospital cardiac arrest drug administration and to assess temporal associations of the Pediatric Advanced Life Support (PALS) guideline changes with drug usage.

METHODS: Pediatric patients <18 years old with in-hospital cardiac arrest recorded in the American Heart Association Get With The Guidelines-Resuscitation database between 2002 and 2018 were included. The annual adjusted odds of receiving each intra-arrest medication was determined. The association between changes in the PALS Guidelines and medication use over time was assessed interrupted time series analyses.

RESULTS: A total of 6107 patients were analyzed. The adjusted odds of receiving lidocaine (0.33; 95% CI, 0.18, 0.61; p < 0.001), atropine (0.19; 95% CI 0.12, 0.30; p < 0.001) and bicarbonate (0.54; 95% CI 0.35, 0.86; p = 0.009) were lower in 2018 compared to 2002. For lidocaine, there were no significant changes in the step (-2.1%; 95% CI, -5.9%, 1.6%; p = 0.27) after the 2010 or 2015 (Step: -1.5%; 95% CI, -8.0%, 5.0; p = 0.65) guideline releases. There were no significant changes in the step for bicarbonate (-2.3%; 95% CI, -7.6%, 3.0%; p = 0.39) after the 2010 updates. For atropine, there was a downward step change after the 2010 guideline release (-5.9%; 95% CI, -10.5%, -1.3%; p = 0.01).

CONCLUSIONS: Changes to the PALS guidelines for lidocaine and bicarbonate were not temporally associated with acute changes in the use of these medications; however, better alignment with these updates was observed over time. A minor update to the language surrounding atropine in the PALS text was associated with a modest acute change in the observed use of atropine. Future studies exploring other factors that influence prescribers in pediatric IHCA are needed.

Original languageEnglish
JournalResuscitation
Volume158
Pages (from-to)243-252
Number of pages10
ISSN0300-9572
DOIs
Publication statusPublished - Jan 2021

    Research areas

  • Cardiac arrest, Guidelines, Pediatric Advanced Life Support

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