Sequence of advanced airway management and epinephrine administration for paediatric patients with non-shockable out-of-hospital cardiac arrest.
Emergency Medicine Journal · 2026-02-27 · Observational study
Abstract
BACKGROUND: Despite the frequent use of both advanced airway management (AAM) and epinephrine during resuscitation, no studies have evaluated the optimal sequencing of these interventions in paediatric out-of-hospital cardiac arrest (OHCA). We therefore aimed to investigate the association between the sequence of AAM and epinephrine administration and outcomes in paediatric patients with OHCA with non-shockable rhythms. METHODS: This retrospective observational study analysed data from a multicentre OHCA registry in Japan from 2014 to 2022. We included paediatric patients (aged <18 years) with non-shockable OHCA who received AAM (endotracheal intubation or supraglottic airway device placement) and/or epinephrine administration. The primary outcome was 1-month survival, and the secondary outcomes were 1-month favourable neurological outcome (defined as a paediatric cerebral performance category of 1-3) and the return of spontaneous circulation (ROSC). Inverse probability of treatment weighting (IPTW) was applied based on propensity scores to address imbalances in patient characteristics. RESULTS: Of the 952 paediatric patients with non-shockable OHCA (median age (IQR) 2 (0-14) years), 577 (61%) were male. Of these, 455 and 497 belonged to the AAM-first and epinephrine-first groups, respectively. After IPTW, all covariates were well balanced between the AAM-first and epinephrine-first groups (standardised mean difference ≤0.10). Compared with the epinephrine-first group, the AAM-first group showed similar 1-month survival (adjusted OR (aOR), 1.09; 95% CI 0.61 to 1.86), favourable neurological outcome at 1 month (aOR, 0.79; 95% CI 0.12 to 5.07) and ROSC (aOR, 0.98; 95% CI 0.72 to 1.35). CONCLUSIONS: The sequence of AAM and epinephrine administration was not associated with 1-month survival, favourable neurological outcome at 1 month or ROSC in paediatric patients with non-shockable OHCA.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Adrenaline · Cardiovascular drugs · Children · Endotracheal intubation · Mortality & survival · Quality of life & function · Supraglottic airway
Related articles
- Sequence of Successful Epinephrine or Advanced Airway Interventions in Nontraumatic Pediatric Out-Of-Hospital Cardiac Arrest. (Acad Emerg Med, 2026)
- Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest. (JAMA Netw Open, 2024)
- Advanced airway interventions for paediatric cardiac arrest: updated systematic review and meta-analysis. (Resusc Plus, 2025)
- Advanced airway management for pediatric out-of-hospital cardiac arrest: A systematic review and network meta-analysis. (Am J Emerg Med, 2023)
- Cardiorespiratory arrest in children (out of hospital). (BMJ Clin Evid, 2007)
- Pre-hospital airway management and survival outcomes after paediatric out-of-hospital cardiac arrests. (Resuscitation, 2022)