High-dose epinephrine during resuscitation: a word of caution

Article Abstract:

Treatment with epinephrine is a standard procedure for resuscitating patients following cardiac arrest. The standard dose of epinephrine (SDE) is 0.5 to 1.0 milligrams given intravenously. High doses of epinephrine (HDE), up to 10 times higher than the SDE, are commonly used for resuscitation. There is controversy as to whether HDE is a more effective treatment and/or if it produces more complications than SDE. Several different studies that have examined this issue have concluded that HDE does not produce any more unwanted side effects than SDE. However, problems encountered in the design of these studies indicate that this conclusion should be interpreted with caution. For example, in one study appearing in the March 6, 1991 issue of the Journal of the American Medical Association, the number of patients was to small to allow proper statistical comparison between the groups treated with HDE or with SDE. Also, the study included only those patients who survived for at least six hours following resuscitation and drug treatment, so that data concerning the lethal effects of the treatments were not included in the study. However, studies in laboratory animals and in humans with cardiac arrest have shown beneficial results with HDE treatment. Taken together, the results of these studies indicate that further research is needed to determine whether HDE is more effective than SDE, and to verify that treatment with HDE does not cause more complications. In the meantime, it is suggested that the widespread use of HDE for resuscitating patients is not justified. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, editorial

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Potential complications of high-dose epinephrine therapy in patients resuscitated from cardiac arrest

Article Abstract:

Epinephrine is a drug used to resuscitate patients who are in cardiac arrest. The standard dose of epinephrine (SDE) recommended by the American Heart Association Advanced Cardiac Life Support (ACLS) guidelines for resuscitating patients is 0.5 to 1.0 milligrams given intravenously. Recent studies in animals and humans have suggested that higher doses of epinephrine (HDE), up to 10 times higher than the recommended SDE, may produce better results. However, there are many hazardous complications that can develop as a result of treating patients with large doses of epinephrine. Some of these complications include cardiac ischemia (insufficient blood flow in the heart muscle), hyperglycemia (high blood sugar), and hypertension (high blood pressure). To determine if treatment with HDE causes more complications or side effects than treatment with SDE, 68 patients who were resuscitated following cardiac arrest, and survived for at least six hours, were studied. Thirty-three patients were treated with HDE, and 35 were treated with SDE. Following treatment, there were no significant differences in blood pressure, blood glucose levels, nerve disorders, or rates of discharge from the hospital between the two groups; no evidence of additional complications caused by HDE was found. It is concluded that HDE does not increase complications associated with treating patients in cardiac arrest. However, it has still not been determined if HDE is more beneficial than SDE. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest

Article Abstract:

High-dose epinephrine may be more effective than low-dose epinephrine for the initial treatment of patients with cardiac arrest outside the hospital. Among 816 patients with cardiac arrest who were treated by paramedics, 286 were treated with high-dose epinephrine (HDE), 260 were treated with standard-dose epinephrine (SDE) and 270 were treated with high-dose norepinephrine bitartrate (NE). Thirty-seven patients (13%) treated with HDE regained a pulse outside the hospital compared with twenty-two patients (8%) treated with SDE. Fifty patients (18%) in the NDE group were admitted to the hospital, compared with 27 patients (10%) in the SDE group. The number of patients treated with NE who regained a pulse outside the hospital and who were admitted to the hospital was similar to the number treated with HDE. Survival was not significantly higher among patients treated with HDE than among patients in the other two treatment groups.

Evaluation, Noradrenaline, Norepinephrine

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