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What is the right dose of epinephrine?

Mahesh Sharman1, Kathleen L Meert

  • 1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|September 9, 2005
PubMed

Insights

High-dose epinephrine (0.1 mg/kg) offers no survival benefit and may cause harm in pediatric cardiopulmonary resuscitation. Current evidence strongly advises against its use in children experiencing cardiac arrest.

Area of Science:

  • Pediatric Emergency Medicine
  • Cardiology
  • Critical Care

Background:

  • High-dose epinephrine (0.1 mg/kg) has been investigated as a potential treatment during pediatric cardiopulmonary resuscitation (CPR).
  • Previous studies yielded conflicting results regarding its efficacy compared to standard doses.

Observation:

  • A randomized controlled trial by Perondi et al. compared high-dose and standard-dose epinephrine in children with cardiac arrest.
  • Retrospective studies also examined the effects of high-dose epinephrine on survival and return of spontaneous circulation.

Findings:

  • The Perondi et al. trial showed decreased survival rates with high-dose epinephrine.
  • No significant difference in the return of spontaneous circulation was observed between high-dose and standard-dose epinephrine groups.
  • Retrospective data on high-dose epinephrine use in pediatric CPR remain inconsistent.

Implications:

  • The use of high-dose epinephrine in pediatric CPR is not supported by current evidence.
  • There is a potential for increased harm associated with high-dose epinephrine administration in children.
  • Clinicians should adhere to standard-dose epinephrine protocols for pediatric cardiac arrest based on the available cumulative evidence.
Abstract

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