# Physiology-directed Epinephrine Dosing in Pediatric Cardiac Arrest (PEDICA)

> **NIH NIH R01** · CHILDREN'S HOSP OF PHILADELPHIA · 2024 · $822,181

## Abstract

Project Abstract
 Pediatric in-hospital cardiac arrest (IHCA) occurs in >15,000 children annually in the United States, most
of whom do not survive to hospital discharge. As less than 5% of pediatric cardiopulmonary resuscitation
(CPR) guideline recommendations are supported by high-quality evidence, there are significant knowledge
gaps regarding optimal resuscitation techniques. Since pediatric IHCA represents a heterogenous process that
results from the progression of many disease states, CPR physiology and the response to therapies also vary
among patients. Therefore, our group has aimed to advance CPR beyond “one-size-fits-all” care and toward
more patient-specific methods with an overarching objective of developing personalized, physiology-directed
CPR strategies that account for both known patient characteristics and real-time physiology.
 A central component of in-hospital CPR is the administration of epinephrine, which is universally
recommended during cardiac arrest to augment systemic vascular resistance, thereby increasing diastolic blood
pressure (DBP) and coronary perfusion pressure to enhance the likelihood of return of spontaneous circulation
(ROSC). Recent laboratory data and our 2023 clinical study identified substantial variability in the DBP
response to epinephrine and found that a more robust increase in DBP after administration of the first dose of
epinephrine is associated with higher rates of ROSC. As data are conflicting regarding ideal dosing strategies
during pediatric IHCA, we postulate that epinephrine is beneficial during CPR in some clinical scenarios and
potentially deleterious in others. Furthering our understanding of this variability in physiologic response will
facilitate the development of methods of personalized, physiology-directed CPR to improve IHCA outcomes.
 Due to limitations in currently available datasets, a prospectively designed study is necessary to address
this topic. Thus, we will leverage the existing infrastructure in 20 sites of the Pediatric Resuscitation Quality
Collaborative (pediRES-Q), a network specifically designed to study IHCA, to prospectively collect extensive
granular data including epinephrine dose timing and physiologic waveforms from bedside monitoring systems.
In Aim 1, we will examine the physiologic response to epinephrine in greater detail and will build on exciting
preliminary data to expand the applicability of this work to patients without invasive monitoring, investigating
the pulse oximetry waveform as a non-invasive marker of CPR physiology and of epinephrine response in
particular. In Aim 2, we will determine how the physiologic response to epinephrine impacts the relationship
between epinephrine dosing strategies and outcomes. Finally, in Aim 3, through a well-established
collaboration with machine learning experts, we will develop models to predict the response to epinephrine
and subsequent CPR outcomes. The successful completion of these aims will expand our underst...

## Key facts

- **NIH application ID:** 10944195
- **Project number:** 1R01HL175433-01
- **Recipient organization:** CHILDREN'S HOSP OF PHILADELPHIA
- **Principal Investigator:** Ryan William Morgan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $822,181
- **Award type:** 1
- **Project period:** 2024-07-01 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10944195

## Citation

> US National Institutes of Health, RePORTER application 10944195, Physiology-directed Epinephrine Dosing in Pediatric Cardiac Arrest (PEDICA) (1R01HL175433-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10944195. Licensed CC0.

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