Hyperacute effects of non-code dose bolus epinephrine in pediatric cardiac intensive care patients: insights from high fidelity physiologic data

Background Non-code dose boluses of epinephrine are utilized in critically ill pediatric patients during periods of hemodynamic deterioration, often with the hopes of preventing a cardiac arrest. Data regarding the physiologic effects of these administrations are limited. The primary aim of this study was to use high fidelity physiologic data to characterize the effects of intravenous non-code dose bolus epinephrine. Methods Pediatric patients in the cardiac intensive care unit who received non-code dose bolus epinephrine were identified. Those who received fluid boluses or chest compressions within 2 minutes of bolus epinephrine were excluded. ARIMAX analyses were conducted to characterize the time-dependent changes in hemodynamic indices. Cluster analyses were then conducted to determine patterns in hemodynamic changes associated with bolus epinephrine. Results A total of 71 non-code dose bolus epinephrine administrations were included in the final analyses. Heart rate, blood pressure, and renal near infrared spectroscopy all demonstrated statistically significant changes after bolus epinephrine administration. Peak change in each was 40%, 52%, and 9%, respectively, with peaks occurring between 60-seconds and 120-seconds after administration. Three response-based clusters were identified. Conclusion Non-code dose bolus epinephrine is associated with a significant increase in heart rate, blood pressure, and systemic oxygen delivery. Cluster analysis using the peak change identified distinct clinical clusters.