High-dose versus standard-dose epinephrine treatment of cardiac arrest after failure of standard therapy.
OBJECTIVE
To assess the efficacy of high-dose epinephrine (HDE) compared with standard-dose epinephrine (SDE) in emergency department patients in cardiac arrest after SDE failed to improve asystole or ventricular fibrillation.


METHODS
Prospective, multicenter, blinded, controlled trial.


METHODS
Eight academic center emergency departments.


METHODS
One hundred forty patients treated for cardiac arrest.


RESULTS
Primary outcomes were either improvement in cardiac rhythm or return of spontaneous circulation (ROSC). Of the 140 patients enrolled, 78 received HDE and 62 received SDE. Of the 34 patients with ventricular fibrillation, 3 were resuscitated with HDE and 2 with SDE (p = 0.60). Of those with asystole, ROSC occurred in 12 of HDE and 5 of SDE recipients (p = 0.11). No patient had return of significant neurologic function and none survived to hospital discharge. Overall, there was no advantage to HDE after failure of SDE.


CONCLUSIONS
Our results are similar to those of controlled clinical trials comparing HDE with SDE in cardiac arrest.
Sherman
B W
BW
Department of Medicine, Mt. Sinai Medical Center, Cleveland, Ohio, USA.
Munger
M A
MA
Foulke
G E
GE
Rutherford
W F
WF
Panacek
E A
EA
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D004837:Epinephrine