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

Area of Science:

• Emergency Medicine
• Critical Care
• Pharmacology

Background:

• Push-dose epinephrine (PDE) is increasingly utilized in emergency departments (EDs) for managing hypotension in critically ill patients.
• Existing data on PDE's safety, dosing, and efficacy in the ED setting are limited, despite its established use in perioperative care.

Purpose of the Study:

• To evaluate the utilization and dosing patterns of prefilled epinephrine syringes (100 µg/10 mL i.v. bolus) in EDs.
• To determine the need for continuous vasopressor infusions following PDE administration within a large healthcare system.

Main Methods:

• Retrospective multisite cohort study analyzing 386 patients who received at least one dose of PDE.
• Data included demographics, dosing, outcomes, and subsequent vasopressor use.
• Descriptive statistics were used for analysis.

Main Results:

• The median patient age was 69 years; 70.2% required continuous vasopressor infusion post-PDE.
• A median dose of 20 µg PDE was administered, with most patients receiving one or two doses.
• PDE was primarily used in high-acuity cases (ESI Levels 1 and 2); 81.9% were admitted to the ICU, and 15% expired.

Conclusions:

• PDE is commonly administered to older patients with high-acuity conditions in the ED.
• The majority of patients required subsequent vasopressor infusions after PDE.
• Further research is needed to assess if prefilled syringes reduce adverse events and improve ED patient outcomes.