Epinephrine inferior to norepinephrine as initial treatment in children with septic shock

1. Epinephrine was associated with greater 30-day mortality compared to norepinephrine in the management of septic shock in pediatric patients.

Evidence Rating Level: 2 (Good)

Vasoactive agents remain the therapeutic option of choice in the management of septic shock in children who have not adequately responded to intravenous fluid resuscitation alone. In adults, norepinephrine remains the clear first line vasoactive agent of choice. However, there are few studies comparing the effectiveness of epinephrine and norepinephrine in children with septic shock. This study therefore sought to investigate outcomes in children with septic shock who were treated with either agent. 231 children (median[IQR] age, 11.4[5.6-15.4] years); 54.6% female) from the Boston Children’s Hospital with septic shock who were treated with epinephrine (n = 147) or norepinephrine (n = 84) were included in the analysis. The primary outcome of the study was MAKE30 which was a composite outcome including death or renal function-related outcomes such as persistent kidney dysfunction by 30 days of hospital discharge, whichever occurred first. Secondary outcomes included 30 day in-hospital mortality. There was no statistically significant difference in the number of children who met MAKE30 between children who received epinephrine or norepinephrine (6.1% vs 3.6% respectively). Epinephrine was associated with greater 30-day mortality compared to norepinephrine  (3.7 vs 0%; risk difference: 3.7%; 95% CI, 0.2% to 7.2%). Overall, this study found that among children with septic shock requiring vasoactive agents, epinephrine was associated with greater 30-day mortality compared to norepinephrine. 

Click to read the study in JAMA Network Open

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