High-dose epinephrine improves outcome from pediatric cardiac arrest

Annals of Emergency Medicine
M G Goetting, N Paradis


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. Prospective intervention versus historic control groups. 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). Treatment with an additional SDE versus HDE (0.2 mg/kg). 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. 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.


Jan 1, 1990·Resuscitation·C Brown, H A Werman
Nov 1, 1990·Annals of Emergency Medicine·N Paradis, E M Koscove
Feb 23, 1990·JAMA : the Journal of the American Medical Association·N ParadisR M Nowak
Sep 1, 1989·Annals of Emergency Medicine·E R GonzalezE M Racht
Aug 1, 1989·Critical Care Medicine·K B KernG A Ewy
Oct 1, 1987·Annals of Emergency Medicine·A ZaritskyK Kuehl
May 1, 1986·Critical Care Medicine·J GillisJ Edmonds
Mar 1, 1986·Pediatric Emergency Care·D G NicholsS Ludwig
Jul 1, 1985·The American Journal of Emergency Medicine·G FleisherK Belani
Jul 1, 1974·Progress in Cardiovascular Diseases·J I Haft
Jul 22, 1982·The New England Journal of Medicine·M R BristowE B Stinson
Nov 1, 1984·The American Journal of Medicine·J WortsmanP E Cryer
Dec 1, 1984·American Journal of Diseases of Children·D E TorphyB M Thompson
May 1, 1983·Annals of Emergency Medicine·J K LewisM K Witte
Mar 1, 1963·Anesthesiology·J S REDDING, J W PEARSON
Sep 1, 1963·Anesthesia and Analgesia·J W PEARSON, J S REDDING


Mar 6, 1991·JAMA : the Journal of the American Medical Association·M CallahamS Kayser
Apr 6, 2004·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Joanne Guay, Louise Lortie
Sep 3, 2013·Seminars in Fetal & Neonatal Medicine·Vishal S Kapadia, M H Wyckoff
Jul 8, 1998·Pediatric Clinics of North America·M N FrandJ R Hageman
May 1, 1996·Paediatric Nursing·R Macnab
Oct 8, 1992·The New England Journal of Medicine·I G StiellG E Dickinson
Apr 23, 2004·The New England Journal of Medicine·Maria Beatriz M PerondiR A Berg
Apr 1, 2005·Current Opinion in Pediatrics·Annalise Sorrentino
Sep 9, 2005·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Mahesh Sharman, Kathleen L Meert
Mar 7, 2009·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·A Zaritsky
Feb 22, 2008·Journal of Veterinary Internal Medicine·S J Plunkett, M McMichael
Aug 8, 2002·Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association
Aug 18, 2016·European Heart Journal. Cardiovascular Pharmacotherapy·Andreas LundinPeter Lundgren
Mar 20, 2012·Resuscitation·Todd M LarabeeCharles M Little
Mar 13, 2010·The American Journal of Emergency Medicine·Meng-Hua ChenFeng-Qing Song
Jan 5, 2005·Resuscitation·Jesús López-HerceSpanish Study Group of Cardiopulmonary Arrest in Children
May 25, 1999·The American Journal of Emergency Medicine·P B Richman, A H Nashed
Aug 1, 1995·Annals of Emergency Medicine·M G Angelos, D J DeBehnke
Jul 27, 2001·Anesthesiology Clinics of North America·J Charney, R K Hamid
Feb 1, 1997·Pediatric Clinics of North America·H M Ushay, D A Notterman
Feb 1, 1993·Annals of Emergency Medicine·J P Ornato
Mar 15, 2002·Anesthesiology Clinics of North America·Jeffrey P Morray
Feb 6, 2002·Emergency Medicine Clinics of North America·Kathleen Brown, Jennifer Bocock
Aug 3, 2012·Journal of Veterinary Emergency and Critical Care·Elizabeth A RozanskiRECOVER Advanced Life Support Domain Worksheet Authors
Aug 25, 2001·Seminars in Neonatology : SN·M H WyckoffS Niermeyer
Mar 27, 2001·The Veterinary Clinics of North America. Small Animal Practice·P F MoonP J Pascoe
May 1, 1994·Annals of Emergency Medicine·P E PepeC G Brown
Apr 1, 1995·Annals of Emergency Medicine·R W HickeyA M Dietrich
Feb 1, 1993·Annals of Emergency Medicine·D J BurchfieldR N Goldberg
Aug 1, 1992·Annals of Emergency Medicine·S A Grant, R S Hoffman
Nov 1, 1994·The American Journal of Emergency Medicine·R F PolglaseB Camp
Jul 1, 2011·Korean journal of anesthesiology·Josef Holzki
Sep 5, 2018·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Pamela D Reiter
Jan 24, 2006·Anesthesia and Analgesia·Conán L McCaulBrian P Kavanagh
Feb 3, 1999·Journal of Paediatrics and Child Health·D P TuthillR Wilson
Feb 3, 1999·Journal of Paediatrics and Child Health·A I O'DonnellY M Rogers
Oct 17, 2002·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·T J WuNeonatal Resuscitation Program
Jul 1, 1991·DICP : the Annals of Pharmacotherapy·R Sagraves, C Kamper
Apr 17, 2004·Paediatric Anaesthesia·Victoria L Chadwick, Joseph E Arrowsmith
Jul 1, 1994·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·R E Jackson
Jun 14, 2003·The Cochrane Database of Systematic Reviews·A J ZiinoP G Davis

Related Concepts

Brain Hypoxia
Epinephrine Acetate
Cardiac Arrest

Related Feeds

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.