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July 14, 1993

Emergency Medicine

JAMA. 1993;270(2):200-202. doi:10.1001/jama.1993.03510020064019

Research in basic and advanced cardiac life support (ACLS) continues to be one of the most important areas in emergency medicine for investigation and clinical progress. Preliminary studies suggested increased myocardial and cerebral blood flow, an improved balance between myocardial oxygen supply and demand, and improved rates of survival when larger doses (0.2 mg/kg) of epinephrine, compared with standard doses (0.01 to 0.02 mg/kg), were used in studies of cardiac arrest. Several case reports of survival after administration of high-dose epinephrine (HDE) have appeared in the literature. In 1992, three rigorous, large-scale clinical trials comparing survival from cardiac arrest managed with HDE vs standard-dose epinephrine (SDE) were reported.

Stiell et al1 reported the outcomes of 650 patients who were randomized to receive either HDE (7 mg) or SDE (1 mg) for up to five doses while undergoing otherwise standard ACLS protocols in the resuscitation of cardiac arrest (ventricular fibrillation,