Epinephrine in Resuscitation: Curse or Cure?

Robert R Attaran; Gordon A Ewy

Disclosures

Future Cardiol. 2010;6(4):473-482. 

In This Article

Epinephrine Dosing

In animal studies, higher doses of epinephrine have been found to cause myocardial necrosis[48] and to be harmful in resuscitation.[49,50] Several human studies have evaluated higher doses of epinephrine in human cardiac arrest. Among children with in-hospital cardiac arrest, once standard-dose epinephrine had failed, rescue high doses of epinephrine did not alter ROSC or survival compared with a standard dose.[51]

Woodhouse et al. evaluated 194 patients with cardiac arrest.[52] A total of 94 patients were randomized to receive two ampoules of 10 mg intravenous epinephrine 5–10 min apart versus 100 patients who received placebo. Both groups could subsequently be administered 1-mg doses of epinephrine, as per American Heart Association guidelines. In addition, 145 patients who met the inclusion criteria were not randomized, as the supervising medical staff chose to administer open-label 1 mg epinephrine ampoules rather than risk using placebo. Data from this group was retrospectively included in the analysis (as a registry). There was no significant difference in the rate of survival or hospital discharge between initial high-dose epinephrine versus placebo. The authors also found no difference in survival or hospital discharge in the open-label standard epinephrine (registry) group compared with the early high-dose epinephrine and early placebo groups. Despite the several limitations of this study, high-dose epinephrine is not recommended.

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