(1625) Early Epinephrine Infusion in Pediatric Hypotensive Septic Shock: A Randomized Clinical Trial

Introduction: Early vasoactive initiation may correct shock quickly and potentially prevent fluid overload in severely shocked children. We compared early epinephrine initiation against standard care in children with hypotensive septic shock.

Methods: Children aged 12 years or younger with hypotensive septic shock presented between March 2020 and June 2021 were randomly assigned to receive either early epinephrine (0.1mcg/kg/min) or placebo (0.9% saline) within 5 minutes of starting fluid bolus in a double-blind design. The infusions were continued till resolution of shock. Open label vasoactives were started at the discretion of treating team and according to standard guidelines. Primary outcome was resolution of shock at one hour of resuscitation.

Results: The study was terminated after enrolling 50 children due to pandemic and slow recruitment; 25 each in epinephrine and placebo group. End points of shock were achieved at one hour in 18 (36%) children; 8 (32%) in epinephrine group and 10 (40%) in placebo group [RR: 0.8, 95%CI: 0.38-1.69; p=0.55]. Resolution of shock at 6 hours [n=30, 60%] were also comparable [14 (56%) vs 16 (64%); RR: 0.88, 95%CI: 0.56-1.38; p=0.23]. Lactate clearance was similar at 6 hours [29% vs 36.6%; p=0.29] but it was significant lower at 24 hours in adrenaline group [50% vs 64%; p=0.03]. Bolus fluid volume at 24 hours [29.6 (8.6) vs 31.6 (10.7) ml/kg], need for open label adrenaline [19 (76%) vs 24 (96%)] and invasive ventilation [23 (92%) vs 20 (80%)] were similar. Fourteen (28%) children died, 7 in each group.

Conclusions: Our preliminary data showed that early epinephrine infusion did not result in greater resolution of shock as compared to standard care.