High-Dose Epinephrine During Resuscitation

Many clinicians have begun to use high-dose epinephrine (HDE) rather than standard-dose epinephrine (SDE) during cardiopulmonary resuscitation.1-6(HDE is usually defined as an intravenous bolus of >1 mg, often 0.2 mg/kg, and SDE is usually defined as a 0.5- to 1.0-mg intravenous bolus.) In animal models, HDE improves measurements of hemodynamics, enhances blood flow in the coronary and cerebral circulation during resuscitation, and brings a higher rate of return of spontaneous circulation than SDE.7-10Anecdotal case reports2-6and preliminary hemodynamic results in humans are consistent with the observations in animals,11but no prospective, controlled study has yet proved that higher doses of epinephrine improve survival or other measures of outcome from cardiac arrest in humans. Other clinicians and scientists have voiced a concern that HDE may be detrimental, especially during ischemia and ventricular fibrillation. Since a fibrillating heart consumes oxygen at a rapid rate,12-16HDE