Push-Dose Epinephrine Utilization in the Emergency Department - A Multi-Center Study

Push-dose epinephrine (PDE) is increasingly used in emergency departments (EDs) to manage hypotension in critically ill patients. Although the use of PDE has been well established in perioperative settings, there are limited data on its safety, dosing, and efficacy in the ED.

Our objective was to evaluate the utilization and dosing patterns for prefilled epinephrine syringes (100 µg/10 mL i.v. bolus) and whether a continuous vasopressor infusion was required after PDE in a large integrated health care system's EDs.

This retrospective multisite cohort study analyzed 386 patients who received at least one dose of PDE between January 1, 2020 and December 31, 2021. Data collected included demographic information, dosing patterns, outcomes, and the need for subsequent vasopressor infusions. Statistical analysis was conducted using descriptive statistics.

The median age of the cohort was 69 years, with 70.2% of patients requiring a continuous vasopressor infusion after the administration of PDE. A total of 719 doses of PDE were given, with a median dose of 20 µg. Of the 386 patients, 81.9% were admitted to the intensive care unit, and 15% expired. The study found that PDE was predominantly used in high-acuity cases (Emergency Severity Index Levels 1 and 2), with most patients receiving one or two doses.

Our study found that PDE was commonly used in older patients with high-acuity conditions, and that most patients required subsequent vasopressor infusions. Further study is necessary to determine if ready-made prefilled syringes decrease adverse events and improve patient outcomes in the ED.