Bolus administration of 5 mg epinephrine as a treatment of last resort for cardiac arrest

Abstract

There is some evidence that the dose of epinephrine currently recommended for resuscitation is low. This study examines the effect of bolus administration of 5 mg of epinephrine when given as an agent of last resort for cardiac arrest. The experimental design called for the administration of high-dose epinephrine at the point where resuscitative efforts would have ordinarily been stopped. Resuscitation was then continued for a minimum of five minutes so that any changes in rhythm or return of spontaneous circulation could be noted. Eighty-five consecutive patients undergoing resuscitation in our Emergency Department were enrolled in this study. Twenty-eight (33 percent) exhibited a change in cardiac rhythm. Of these 28 patients, seven (8 percent) developed pulses. Of these seven patients, four expired in the Emergency Department, one survived to admission but expired two days later, and two patients survived to discharge. We conclude that bolus administration of 5 mg of epinephrine may be useful in treating cardiac arrest refractory to conventional therapy.