• C Barton and M Callaham.
• Department of Medicine, University of California, San Francisco 94143-0208.
• Ann Emerg Med. 1991 Jul 1; 20 (7): 722-5.

Study ObjectivesTo evaluate the return of spontaneous circulation (RSC) rates in human victims of cardiac arrest treated with standard doses of epinephrine (SDE) or high-dose epinephrine (HDE).DesignProspective case series.SettingA university hospital emergency department during 1987 through 1989.ParticipantsForty-nine adult victims of nontraumatic cardiac arrest.InterventionsAt the discretion of the treating physician, patients received epinephrine in bolus doses ranging from 1 to 15 mg. HDE was defined as a dose of at least 0.2 mg/kg; smaller doses were defined as SDE. Patients were grouped as +RSC if they developed a sustained spontaneous palpable pulse or blood pressure and as -RSC if they did not develop a pulse or blood pressure.MeasurementsPatients were grouped as +RSC if they developed a sustained spontaneous palpable pulse or blood pressure and as -RSC if they did not develop a pulse or blood pressure. Patients were also grouped by their presenting rhythm. Potentially perfusing rhythm was electromechanical dissociation or ventricular tachycardia. Nonperfusing rhythm was asystole or ventricular fibrillation. Rates were analyzed using the Fisher exact test and the two-tailed unpaired t test. HDE improved the rate of initial resuscitation (P = .008). The effect was greatest in patients with nonperfusing rhythms (P = .014) and disappeared when evaluating patients with potentially perfusing rhythms. No patient survived to hospital discharge.ConclusionHigh-dose epinephrine improves initial resuscitation rates in human victims of cardiac arrest. Its greatest effect is in patients with a nonperfusing rhythm.

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