[Is high-dose epinephrine justified in cardiorespiratory arrest in children?].
OBJECTIVE
To evaluate the impact on survival of intravenous or intraosseous high-dose epinephrine compared with standard doses in children with cardiorespiratory arrest.


METHODS
We performed a multicenter, prospective study. Cardiopulmonary resuscitation data from 283 children was collected following international guidelines (Utstein style) over 18 months. In a secondary analysis we studied survival in 92 children who were treated with intravenous or intraosseous epinephrine.


RESULTS
One or more conventional doses of epinephrine (0.01 mg/kg) were administered in 12 patients and a first conventional dose followed by one or more high doses (0.1 mg/kg) were administered in 80 patients. The age and weight of children in the conventional-dose group were higher than those in the high-dose group (97.1 +/- 70.5 months vs 29.9 +/- 36.9 months, p = 0.03 and 24.7 +/- 20.8 kg vs 11.9 +/- 8.9 kg, p = 0.037, respectively). The number of doses administered in the conventional-dose group was lower than that in the high-dose group (4 +/- 4 vs 5.4 +/- 3.4, p = 0.01). No significant differences were observed between the two groups in type of arrest, site of arrest, initial electrocardiographic rhythm, response to resuscitation attempts with return of spontaneous circulation, total resuscitation time, neurological status at the end of the episode and survival to hospital discharge and at 1-year of follow-up.


CONCLUSIONS
Although the present study has considerable limitations, the results suggest that high doses of epinephrine do not improve survival in cardiorespiratory arrest in children.
Rodríguez Núñez
A
A
Servicio de Críticos y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. Antonio.Rodriguez.Nunez@sergas.es
García
C
C
López-Herce Cid
J
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage*; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies
D004837:Epinephrine