470 - A Novel Method for Administering Epinephrine during Neonatal Resuscitation

Poster Number: 470
Publication Number: 470.230

Hannah S. Gu, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States; Juliana R. Perl, Stanford University School of Medicine, Stanford, CA, United States; William D. Rhine, Stanford University School of Medicine, Palo Alto, CA, United States; Nicole K. Yamada, Stanford University School of Medicine, Palo Alto, CA, United States; Megan L. Ringle, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Palo ALto, CA, United States; Jules P. Sherman, Children's National Hospital, Palo Alto, CA, United States; Alexandra McMillin, Stanford University School of Medicine, Pleasanton, CA, United States; Janene Fuerch, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Epinephrine is used infrequently in neonatal resuscitation, but timely and accurate administration can be lifesaving in bradycardic infants. The current method of preparing epinephrine is inefficient and error-prone, requiring weight-based dosing and assembly of a 10-mL glass syringe. Previous work has shown that cognitive aids in simulated environments reduced error rates in epinephrine administration but not time needed for epinephrine administration. For other high acuity drugs, the use of prefilled medication syringes has decreased medication error and administration time.

Objective: To determine if prefilled epinephrine syringes will reduce time to epinephrine administration compared to conventional epinephrine in simulated neonatal resuscitations.

Design/Methods: We recruited 21 nurses from the neonatal intensive care unit (NICU). Each participant engaged in 4 simulated scenarios resuscitating either a term or preterm manikin using either conventional epinephrine (ABBOJECT, Pfizer, Inc, New York, NY) or novel prefilled epinephrine syringes specified for patient weight and administration route (Figure 1). Each participant was asked to prepare and administer a specified volume of epinephrine during video-recorded scenarios. Two investigators analyzed the videos for the time needed for epinephrine preparation and administration. Differences between the conventional and novel techniques were evaluated using two-sample t-tests assuming unequal variances.

Results: Twenty-one participants completed 42 scenarios with conventional epinephrine and 42 scenarios with novel prefilled syringes. Time for epinephrine preparation significantly decreased with novel prefilled epinephrine syringe use (M 19.3 sec, SD 8.0) compared to conventional epinephrine (M 48.8 sec, SD 10.5), t(77) = 14.5, p < 0.001. Time for epinephrine administration also significantly decreased with the use of novel prefilled epinephrine syringes (M 29.8 sec, SD 11.0) compared to conventional epinephrine (M 59.0 sec, SD 11.5), t(82) = 11.9, p < 0.001. In a post-experiment survey, all participants responded “completely agree” to the following statements: "prefilled syringes improved time to medication delivery", "the use of prefilled syringes would positively impact patient outcomes", and “I support the adoption of prefilled syringes for epinephrine delivery”.Conclusion(s): In a simulated neonatal resuscitation environment, the use of novel prefilled epinephrine syringes significantly decreases the time for epinephrine preparation and administration, which may decrease the time to return of spontaneous circulation in the clinical environment.
Curriculum VitaeCV_Gu_2021.pdf