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Research Letter
April 2017

Accuracy of Prefilled “Code Cart” Epinephrine Syringes for Direct Administration of Small Doses

Author Affiliations
  • 1Department of Emergency Medicine, Oregon Heath & Science University, Portland
  • 2Department of Pediatrics, Oregon Health & Science University, Portland
  • 3Department of Pharmacy Services, Oregon Health & Science University, Portland
  • 4Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
  • 5Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
JAMA Pediatr. 2017;171(4):393-394. doi:10.1001/jamapediatrics.2016.4167

Prefilled syringes offer a convenient way to administer epinephrine to patients experiencing cardiac arrest. Epinephrine is a critical drug that can improve survival in children experiencing cardiac arrest, although very high doses (0.1 mg/kg) of the drug can worsen outcomes.1,2 One practice for administering epinephrine during pediatric resuscitation is direct administration of a partial volume from commercially available prefilled syringes. We conducted a study examining the accuracy of direct injection of an infant dose (0.05 mg or 0.5 mL) of epinephrine from prefilled epinephrine syringes using the graduated lines on the syringe. We used the recommended dose in the Pediatric Advanced Life Support algorithm (0.01 mg/kg), although the Neonatal Resuscitation Program includes a range of 0.01 mg/kg to 0.03 mg/kg. We hypothesized that direct injection may yield inaccurate doses.

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