High-dose epinephrine improves the return of spontaneous circulation rates in human victims of cardiac arrest.

STUDY OBJECTIVES

To evaluate the return of spontaneous circulation (RSC) rates in human victims of cardiac arrest treated with standard doses of epinephrine (SDE) or high-dose epinephrine (HDE).

DESIGN

Prospective case series.

SETTING

A university hospital emergency department during 1987 through 1989.

PARTICIPANTS

Forty-nine adult victims of nontraumatic cardiac arrest.

INTERVENTIONS

At the discretion of the treating physician, patients received epinephrine in bolus doses ranging from 1 to 15 mg. HDE was defined as a dose of at least 0.2 mg/kg; smaller doses were defined as SDE. Patients were grouped as +RSC if they developed a sustained spontaneous palpable pulse or blood pressure and as -RSC if they did not develop a pulse or blood pressure.

MEASUREMENTS

Patients were grouped as +RSC if they developed a sustained spontaneous palpable pulse or blood pressure and as -RSC if they did not develop a pulse or blood pressure. Patients were also grouped by their presenting rhythm. Potentially perfusing rhythm was electromechanical dissociation or ventricular tachycardia. Nonperfusing rhythm was asystole or ventricular fibrillation. Rates were analyzed using the Fisher exact test and the two-tailed unpaired t test. HDE improved the rate of initial resuscitation (P = .008). The effect was greatest in patients with nonperfusing rhythms (P = .014) and disappeared when evaluating patients with potentially perfusing rhythms. No patient survived to hospital discharge.

CONCLUSION

High-dose epinephrine improves initial resuscitation rates in human victims of cardiac arrest. Its greatest effect is in patients with a nonperfusing rhythm.