Estudio comparativo entre dosis alta y dosis estándar de epinefrina en el paro cardiorrespiratorio en niños
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La dosis óptima de epinefrina (Epi) en el paro cardiorrespiratorio (PCR) se desconoce. Estudios recientes sugieren que la Epi en dosis alta (EDA), 10 o 20 veces mayor que la dosis estándar (EDE), es más efectiva en el PCR en niños, con mayor reinicio de la circulación espontánea (RCE), sobrevida y menos secuelas neurológicas. Realizamos un estudio prospectivo, controlado, abierto, aleatorizado para comparar la EDA vs la EDE en el PCR en pacientes pediátricos en el Hospital Central Militar (HCM).
Material y métodos. Se estudiaron 22 pacientes pediátricos con asistolia en el Departamento de Pediatría del HCM, que recibieron EDA (0.1 mg/kg) o EDE (0.01 mg/ kg) en forma aleatorizada, con el manejo del PCR de acuerdo a los lineamientos de la Asociación Americana del Corazón y la Academia Americana de Pediatría. Se midió la frecuencia de RCE, sobrevida y secuelas neurológicas en los sobrevivientes,
Resultados. Dos pacientes (20%) del grupo de estudio (EDA) tuvieron REC y sólo uno (10%) de ellos sobrevivió al egreso hospitalario, con retraso psicomotor moderado. En el grupo control ninguno tuvo RCE, ni sobrevivió al evento de PCR. No encontramos diferencia significativa en cuanto al tiempo de duración del PCR, número de dosis de epinefrina, complicaciones, toxicidad, y etiología del PCR.
Conclusiones. No encontramos diferencia significativa en el REC, sobrevida y secuelas neurológicas con el uso de EDA en pacientes pediátricos con PCR intrahospítalario, a diferencia de lo reportado en la literatura. Si existe un efecto benéfico de la EDA en el PCR, probablemente no sea clínicamente importante, se sugieren estudios con grupos mayores de pacientes.
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