PEA PUSH EPI EARLY P

Although delays in epinephrine administration following pediatric IHCA with an initial nonshockable rhythm of pulseless electric activity or asystole are common, there is substantial hospital variation in rates of delayed epinephrineadministration. Differences across hospitals explained a substantial degree of the variation in rates of delayed epinephrine administration, but few facility characteristics were found to explain this variation. Asystole and insertion of an endotracheal tube were the only patient/event-level predictors of delayed epinephrine administration, and bed volume less than 200 beds compared with greater than or equal to 500 beds and ICU location were the only hospital-level characteristics found to be associated with delayed epinephrine administration. Hospital rates of ROSC, 24-hour survival, and survival to discharge are inversely correlated with hospital rates of delayed epinephrine. After adjusting for relevant factors, patient- and hospital-level delayed epinephrine administration was associated with lower event and 24-hour survival across increasing quartiles of epinephrine delay. Given extensive differences in epinephrine administration time across institutions and the recognized impact of delayed epinephrine on survival, new approaches to improve hospital performance in epinephrine administration time could represent a critical area for quality improvement. Further studies are needed to determine if improving hospital performance on time to epinephrine administration, especially at hospitals with poor performance on this metric, will lead to improvement in outcomes.

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