What dose of epinephrine is being used in pediatric resuscitation? Results of a survey.
Standard-dose epinephrine (SDE) currently recommended by the American Heart Association for pediatric resuscitation is 0.01 mg/kg (0.1 ml/kg of 1:10,000 solution). SDE has come under increasing scrutiny; many authors suggest that this dose is too small. We sought to determine current epinephrine dosing practices among physicians practicing pediatric emergency medicine. Half of the members of the American Academy of Pediatrics Emergency Medicine section, selected randomly, were surveyed by a mailed questionnaire. After two mailings, 105 of 162 surveys (65%) were completed by members in practice. Of the 105 responders, 59% described their practice as "pediatric emergency medicine"; 17% as "emergency medicine (children and adults)"; 10% as "general pediatric practice or clinic"; 10% as "critical care"; and 5% as "other." Fifty-one (49%) had completed fellowship training, and 81 (77%) were either PALS or APLS instructors (referred to as "instructors" below). Overall, 72% (76/105) indicated that they use doses larger than SDE. Sixty-five of these (86%) described their dosing practice as "recommended dose initially, then larger dose." Twenty-one percent use SDE less than half of the time, and 16% use a dose 10 to 20 times larger at least half of the time. No responder used doses smaller than SDE. Instructors were more likely to use larger doses than were noninstructors (83% compared with 38%; P < 0.001). In the instructor group, a significantly larger dose was being taught "informally" than "formally" (P < 0.001). This survey was undertaken to determine current dosing practices by a group of physicians who are knowledgeable and experienced in pediatric resuscitation, not to resolve the question of the optimal dose of epinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)
Schunk
J E
JE
Emergency Department, Primary Children's Medical Center, Salt Lake City.
Corneli
H M
HM
D000572:American Heart Association; D002170:Canada; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D002648:Child; D004635:Emergency Medicine / Q000592:standards*; D004837:Epinephrine / Q000008:administration & dosage*; D006801:Humans; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014481:United States
D004837:Epinephrine