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March 17, 1993

High-Dose Epinephrine in Cardiopulmonary Resuscitation

Author Affiliations

Northwestern Medical School
Rush-Presbyterian-St Luke's Medical Center Chicago, Ill

JAMA. 1993;269(11):1383. doi:10.1001/jama.1993.03500110051020

To the Editor.  —We read with interest and disappointment of the failure of high-dose epinephrine to improve neurological outcome in cases of adult cardiac arrest.1 We report our limited experience in resuscitation of infants and children with high-dose epinephrine.Four children ranging in age from 11 days to 3 years experienced witnessed cardiopulmonary arrests. The initial treatment according to the advanced cardiac life support standards failed to produce a clinical response. In a last-ditch attempt to revive the children, we initiated a continuous infusion with pressor agents. In the first patient, dopamine hydrochloride (20 μg/kg per minute), dobutamine (20 μg/kg per minute), and epinephrine (10 μg/kg per minute) were given with a resultant ventricular fibrillation rhythm. The patient was then successfully defibrillated and stabilized though severe hypoxemic encephalopathy followed. The technique was used twice afterward with a similar response by the heart. In one of these cases, the patient