P16

EMERGENCY DRUG PREPARATION IN PAEDIATRIC ANAESTHESIA, SHOULD ADRENALINE BE PREPARED?

K. Harvey-Kelly¹, H. Lewis², J. McArdle³, Paediatric Anaesthetic Trainee Research Network⁴, K. Brooks⁵, J. Groome⁵

¹Great Ormond Street Hospital, London, UK

²Evelina Children's Hospital, London, UK

³Great North Children's Hospital, Newcastle-upon-Tyne, UK

⁴APAGBI, London, UK

⁵Barts Health, London, UK

Introduction

The 7th National Audit Project analysed perioperative cardiac arrests in the UK from June 2021 – 2022. The incidence of paediatric perioperative cardiac arrest was 0.03%. There were ten cases of bradycardia causing cardiac arrest in non-cardiac surgery. One key finding was that adrenaline was not used as per Advanced Paediatric Life Support cardiac arrest algorithms in 40% of these cases, either as first line or at all. Atropine or glycopyrrolate was used instead.

The Paediatric Anaesthesia Trainee Research Network Swift Survey 2023 looked at emergency drug preparation in paediatric anaesthesia. We compared the preparation of adrenaline and atropine.

Methods

A MicrosoftForms questionnaire was designed by the Paediatric Anaesthesia Trainee Research Network (PATRN) and the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) Scientific committee. Thirteen questions focussed on preparation of emergency drugs in paediatric anaesthesia and availability of pre-filled syringes. The survey was sent to PATRN and APAGBI members and distributed at the 2023 APAGBI conference.

Results

A total of 183 results were received. The majority of respondents were consultants (n=148; 81%). The majority of respondents draw up emergency drugs; either situation dependent (n=85; 47%) or all the time (n=77; 42%). Atropine was drawn up in 68% (n=125) of cases and adrenaline in 30% (n=54) cases; p<0.001. Looking at high risk cases e.g. neonates, atropine was more frequently prepared n=63; 74% compared to adrenaline n=43; 50% p=0.0015. Ten respondents (5%) do not draw up either atropine or adrenaline.

Two thirds of respondents had pre-filled syringes available at their institution either in every anaesthetic room (45%; n=83) or on the resuscitation trolley (16%; n=29). Pre-filled atropine was available in 26% (n=48) of replies. Pre-filled adrenaline was available in 22% of answers (n=40) of replies.

Display of emergency drug doses was not routinely carried out and there was no clear preferred method when it was done. Almost half of respondents had no method to display emergency drug doses or volumes (47%; n=87). Methods utilised included a whiteboard, reference chart and online app.

Conclusion

Other than Propofol, Atropine is the most commonly drawn up emergency drug by surveyed paediatric anaesthetists. The fact that it is drawn up and ready to use in the majority of cases may explain its use in preference to adrenaline in 40% of bradycardic perioperative arrests recorded in NAP7. Up to date resuscitation training is key to ensuring correct management of cardiac arrest, however, equally ready availability of adrenaline may also help in facilitating this. Use of prefilled syringes for adrenaline and atropine with patient specific doses clearly documented in theatre could enhance patient safety and reduce waste by safely allowing anaesthetists not to draw up patient specific doses of emergency drugs for each patient.

References:

1. At the Heart of the Matter. Report and findings of the 7th National Audit Project of the Royal College of Anaesthetists examining Perioperative Cardiac Arrest. Soar J, Cook TM editors. Royal College of Anaesthetists: 2023. ISBN 978-1-900936-35-4

2.https://www.resus.org.uk/sites/default/files/2021-04/Paediatric%20ALS%20Algorithm%202021.pdf