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March 17, 1993

High-Dose Epinephrine in Cardiopulmonary Resuscitation-Reply

Author Affiliations

University of California, San Francisco

JAMA. 1993;269(11):1383-1384. doi:10.1001/jama.1993.03500110051022

In Reply.  —Drs Polin and Leikin raise some interesting issues, but we disagree with some of their conclusions. We did exclude pediatric patients from our study. Considering that the neurological outcome in pediatric cardiac arrest usually is poor, and certainly is worse than in adult cardiac arrest, we would be fearful that in this age group the results would be grim. This certainly was the case in the study by Goetting and Paradis.1 In a later study by the same authors, high-dose epinephrine produced survivors when standard doses did not, but only a third of pediatric survivors treated with high-dose epinephrine were neurologically intact.2 These poor results also appear to be true of the cases of Drs Polin and Leikin.When I first started prescribing high-dose epinephrine about 5 years ago, I too chose a continuous drip method. I no longer do. Physiologically, a bolus followed by a