How to avoid epinephrine dosing errors in infants? JAMA study provides insight

USA: A simple emergency medical services (EMS) intervention employing a 1-mL syringe for tiny epinephrine doses was linked to a higher rate of proper epinephrine dose administration without lowering delivery speed, says an article published in the Journal of American Medical Association.

Because of the potential for decimal translation errors (leading to 10-fold errors) and the inaccuracy in providing lower doses using frequently provided (1 mg/10 mL) prefilled epinephrine syringes, the smallest children are at the highest risk of epinephrine dosing errors. As a result, Matt Hansen and colleagues undertook this study to see if a simulation-driven emergency medical services protocol change that uses a 1-mL syringe to provide tiny epinephrine doses lowers dosage errors in newborns.

Researchers ran simulations in two separate time periods for this quality improvement study, and data were collected in real-time during the simulation situations. The SQUIRE reporting requirements were followed for this study. All simulations were carried out in real-time, with the same infant simulator and EMS agencies in a large regional EMS system where complex life support–capable public fire and private transfer units react to all calls for service. To compare the 2016 and 2020 data, a 2-tailed Fisher exact test was used; this test was chosen due to the very small sample sizes. Stata version 15 was used for all statistical analyses.

The key findings of this study were as follows:

1. This study enlisted the help of 432 EMS workers.

2. In 2016, a total of 47 neonatal cardiac arrest simulations were performed, involving approximately 15% of the area's EMS staff.

3. Two simulations were eliminated due to audio/video issues and a lack of participant permission.

4. 39 newborn cardiac arrest simulations were performed in 2020.

5. From 2016 to 2020, the proportion of patients receiving epinephrine climbed considerably.

6. From 2016 to 2020, the percentage of those who received epinephrine who received an acceptable dose grew considerably.

7. The time to give epinephrine dropped from a mean (SD) of 395 (30) seconds in the 2016 simulations to 322 (18) seconds in the 2020 simulations while using the 1-mL syringe.

In conclusion, this study's shortcomings include its empirical approach and use of a single urban EMS system. These data imply that a comparable technique could help reduce epinephrine dose errors in newborns.

Reference:

Hansen M, Walker-Stevenson G, Eriksson C, et al. Analysis of an Intervention for Emergency Medical Services Personnel to Reduce Epinephrine Dosing Errors in Infants. JAMA Netw Open. 2022;5(4):e227645. doi:10.1001/jamanetworkopen.2022.7645