{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T19:06:21Z","timestamp":1774119981637,"version":"3.50.1"},"reference-count":58,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The optimal sequence of epinephrine administration and advanced airway management (\n                      <jats:styled-content style=\"fixed-case\">AAM<\/jats:styled-content>\n                      ) successfully delivered during pediatric out\u2010of\u2010hospital cardiac arrest (\n                      <jats:styled-content style=\"fixed-case\">OHCA<\/jats:styled-content>\n                      ) is unclear. Our objective was to determine whether the sequence of first successful epinephrine administration and first successful\n                      <jats:styled-content style=\"fixed-case\">AAM<\/jats:styled-content>\n                      is associated with survival and functional outcomes in pediatric\n                      <jats:styled-content style=\"fixed-case\">OHCA<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a secondary analysis of the Resuscitation Outcomes Consortium Epidemiologic Registry\u2013Cardiac Arrest, a prospective database from 10 US and Canadian regions (2011\u20132015). We included children (age &lt;\u200918\u2009years) with non\u2010traumatic OHCA who received epinephrine and\/or AAM (endotracheal intubation or supraglottic airway). Our exposure was the sequence of first successful epinephrine administration versus first successful AAM (epinephrine\u2010first or AAM\u2010first). The primary outcome was survival at hospital discharge. Secondary outcomes were a favorable functional outcome at discharge (modified Rankin Scale \u2264\u20093) and return of spontaneous circulation (ROSC) at hospital arrival. We adjusted for group differences using inverse\u2010probability\u2010of\u2010treatment weighting derived from a propensity score and compared outcomes with logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 886 eligible patients, 297 (33.5%) received AAM as the first successful intervention, 558 (63.0%) received epinephrine as the first successful intervention, and 31 (3.5%) received these at the same recorded second. There was no significant difference in survival at discharge between the epinephrine\u2010first and AAM\u2010first groups (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.69\u20131.52). Relative to the AAM\u2010first group, the epinephrine\u2010first group was associated with higher odds of ROSC at hospital arrival (OR, 1.38; 95% CI, 1.06\u20131.80) but lower odds of favorable functional outcome at hospital discharge (OR, 0.32; 95% CI, 0.13\u20130.76).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this large observational study of pediatric OHCA, the observed sequence of first successful epinephrine administration and first successful AAM was not associated with survival to hospital discharge.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70225","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T21:00:03Z","timestamp":1769461203000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sequence of Successful Epinephrine or Advanced Airway Interventions in Nontraumatic Pediatric Out\u2010Of\u2010Hospital Cardiac Arrest"],"prefix":"10.1111","volume":"33","author":[{"given":"Shunsuke","family":"Amagasa","sequence":"first","affiliation":[{"name":"Department of Emergency and Transport Medicine National Center for Child Health and Development  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu","family":"Utsumi","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine Graduate School of Biomedical and Health Sciences, Hiroshima University  Hiroshima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoko","family":"Uematsu","sequence":"additional","affiliation":[{"name":"Department of Emergency and Transport Medicine National Center for Child Health and Development  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1389-5726","authenticated-orcid":false,"given":"Sriram","family":"Ramgopal","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Berg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Okubo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001303"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2018.01.040"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2018.04.030"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2023.109942"},{"key":"e_1_2_15_6_1","first-page":"S479","article-title":"Part 8: Pediatric Advanced Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"152","author":"Lasa J. 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