High-dose epinephrine improves outcome from pediatric cardiac arrest.
OBJECTIVE
Animal studies suggest that the standard dose of epinephrine (SDE) for treatment of cardiac arrest in human beings may be too low. We compared the outcome after SDE with that after high-dose epinephrine (HDE) in children with refractory cardiac arrest.


METHODS
Prospective intervention versus historic control groups.


METHODS
Two similar groups of 20 consecutive patients each (median ages, 2.5 and 3 years) with witnessed cardiac arrest who remained in arrest after at least two SDEs (0.01 mg/kg).


METHODS
Treatment with an additional SDE versus HDE (0.2 mg/kg).


RESULTS
The rates of return of spontaneous circulation and long-term survival were compared. Fourteen of the HDE group (70%) had return of spontaneous circulation, whereas none of the SDE group did (P less than .001). Eight children survived to discharge after HDE, and three were neurologically intact at follow-up. No significant toxicity from HDE was observed.


CONCLUSIONS
HDE provided a higher return of spontaneous circulation rate and a better long-term outcome than SDE in our series of pediatric cardiac arrest. HDE may warrant incorporation into standard resuscitation protocols at an early enough point to prevent irreversible brain injury.
Goetting
M G
MG
Department of Pediatrics, Henry Ford Hospital, Detroit, Michigan 48202.
Paradis
N A
NA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D006321:Heart / Q000187:drug effects; D006323:Heart Arrest / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D002534:Hypoxia, Brain / Q000517:prevention & control; D007223:Infant
D004837:Epinephrine