HIGH-DOSE EPINEPHRINE IS NOT SUPERIOR TO STANDARD-DOSE EPINEPHRINE INPEDIATRIC IN-HOSPITAL CARDIOPULMONARY ARREST

Objective. To compare the efficacy of high-dose epinephrine (HDE) with that of standard-dose epinephrine (SDE) for resuscitation from in-hos pital pediatric cardiopulmonary arrest (CPA). Design. Fifty-four-month retrospective study of all pediatric patients who had a CPA while hos pitalized at a tertiary care children's hospital. Standard pediatric a dvanced life support techniques were used for all patients. Patients r eceived HDE or SDE in accordance with physician orders and standard pr otocols at the time of CPA. Primary outcome measures were the return o f spontaneous circulation (ROSC), the duration of survival after resus citation, survival to hospital discharge, and Pediatric Overall Perfor mance Category scores at the time of discharge. Results. During the st udy period, 51 patients met entry criteria and had a total of 58 CPAs. Twenty-one patients received HDE during resuscitation from 24 arrests , at a dose of 0.12 +/- 0.05 mg/kg (mean +/- SD); 30 patients received SDE during resuscitation from 34 arrests, at a dose of 0.01 +/- 0.01 mg/kg (mean +/- SD). The HDE and SDE groups were not significantly dif ferent in terms of gender, initial cardiac rhythm, location of CPA, pr imary diagnoses at the time of CPA, initial pH, or additional resuscit ation medications received; the SDE group had a significant higher mea n age, although the median ages were not different. Fourteen of 24 res uscitations using HDE resulted in ROSC (58%) with a mean time to ROSC of 19 minutes; 7 (29%) of 24 led to survival for 24 hours, and 6 (26%) of 23 patients survived to hospital discharge, all with moderate to s evere neurologic and functional impairment. Twenty-four of 34 resuscit ations using SDE resulted in ROSC (71%) with a mean time to ROSC of 12 minutes; 17 (50%) of 34 led to survival for 24 hours; and 7 (23%) of 30 patients survived to hospital discharge, 4 with mild to moderate ne urologic impairment. No significant differences in rates of ROSC, surv ival rates, or Pediatric Overall Performance Category scores of surviv ors were found between the two groups. The mean time to ROSC was signi ficantly longer in the HDE group. Conclusions. In this study, the use of HDE did not improve the rates of ROSC, short-term survival, or long term survival after pediatric in-hospital CPA, nor did it improve over all outcome scores. Given the conflicting evidence surrounding possibl e detrimental effects of HDE use, a large, blinded, prospective trial of HDE use in this setting is necessary to clarify the appropriate rol e for HDE in pediatric resuscitation.