High dose epinephrine in refractory pediatric cardiac arrest

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Abstract
Cardiac arrest has a poor prognosis, regardless of age group. Children who fail to respond to two standard doses of epinephrine (0.01 mg/kg) rarely survive to hospital discharge, and most die without the return of spontaneous circulation (ROSC). We treated seven consecutive children in cardiac arrest with high dose epinephrine (0.2 mg/kg) after failure to respond to two standard doses. Six had prompt and sustained ROSC. By comparison, in the previous 20 consecutive pediatric patients with cardiac arrest in which there was no response to two standard doses of epinephrine, none had ROSC. Previous animal data as well as anecdotal human experience suggest that the standard epinephrine dose (0.01 mg/kg) may be much too low. (Crit Care Med 1989; 17:1258)