The Use of High-Dose Epinephrine for Patients With Out-of-Hospital Cardiopulmonary Arrest Refractory to Prehospital Interventions

Abstract

HDE does not improve or diminish return of spontaneous circulation, 24-hour survival, long-term survival, or neurological outcome compared with SDE in out-of-hospital cardiopulmonary arrest.

Part 15: Neonatal Resuscitation

“…Higher IV doses are not recommended because animal 86,87 and pediatric 88,89 studies show exaggerated hypertension, decreased myocardial function, and worse neurological function after administration of IV doses in the range of 0.1 mg/kg. If the endotracheal route is used, doses of 0.01 or 0.03 mg/kg will likely be ineffective.…”

Part 11: Neonatal Resuscitation

“…Evidence extrapolated from pediatric studies that included infants Ͻ1 year of age (LOE 5 104,105 ) indicate no benefit from intravenous epinephrine doses Ն0.03 mg/kg. This is in contrast to a single pediatric case series using historic controls that indicated a marked improvement in ROSC using high-dose intravenous epinephrine (0.1 mg/kg) among children who had not responded to 2 doses of standard epinephrine (0.01 mg/kg) (LOE 5 106 ).…”

Part 14: Pediatric Advanced Life Support

“…There is no survival benefit from high-dose epinephrine, and it may be harmful, particularly in asphyxia (Class III, LOE B). [257][258][259][260][261] Highdose epinephrine may be considered in exceptional circumstances, such as ␤-blocker overdose (Class IIb, LOE C).…”