Table 2.
Doses of epinephrine for different outcomes among patients with cardiac arrest.
| Author | Year | Country | Setting | Initial Cardiac Rhythm | Design | Primary Outcome | Primary Findings | Additional Outcomes | Additional Findings | Conclusion |
|---|---|---|---|---|---|---|---|---|---|---|
| Brown, et al. [14] | 1992 | United States | OHCA | Shockable | Randomized Control Trial | Return of Spontaneous Circulation | 30% standard dose epi vs. 33% high dose epi (99% CI, −10 to 3) | Hospital Admission, Hospital Discharge, Conscious at Hospital Discharge (of survivors) |
Hospital Admission: 22% standard dose vs. 22% high-dose (99% CI, −7 to 5) Hospital Discharge: 4% standard dose vs. 5% high-dose (99% CI, −4 to 2) Conscious at Hospital Discharge: 92% standard dose vs. 94% high-dose (99% CI, −20 to 16) |
When comparing 0.02 mg of epinephrine per kg of body weight to a higher dose of 0.2 mg per kg, there was no statistically significant difference between ROSC, survival to hospital admission or discharge, or neurological outcome. |
| Stiell, et al. [15] | 1992 | Canada | OHCA, IHCA | Non-Shockable, Shockable | Randomized Control Trial | Survival for One Hour | 23% standard dose epi vs. 18% high dose epi (95% CI, −1 to 12; p-value = 0.12) | ROSC, Hospital discharge, Cerebral performance | ROSC: 32% standard dose vs. 38% high dose (p-value = 0.15) Hospital Discharge: 5% standard dose vs. 3% high dose (95% CI, −2 to 5; p-value = 0.38) Cerebral Performance: 94% standard dose vs. 90% high dose (p-value = 0.24) |
Comparing 1 mg (standard dose) of epinephrine to 7 mg (high dose) showed no statistically significant difference in ROSC, survival for one-hour or to discharge, or cerebral performance even when controlling for OHCA vs. IHCA. |
| Gueugniaud, et al. [16] | 1998 | France, Belgium | OHCA | Non-Shockable, Shockable | Randomized Control Trial | Return of Spontaneous Circulation | 34.4% standard dose epi vs. 38.0% high dose epi (95% CI, 0.6 to 6.6; p-value = 0.02) | Hospital Admission, Hospital Discharge, Neurologic Outcomes | Hospital Admission: 23.6% standard dose vs. 26.5% high dose (p-value = 0.05) Hospital Discharge: 2.8% standard dose vs. 2.3% high dose (p-value = 0.34) Good Neurologic Outcomes: 71.7% standard dose vs. 76.3% high dose (p-value = 0.64) |
There was a statistically significant difference in ROSC and survival to admission between patients receiving up to 15 doses of 5 mg of epinephrine compared to standard 1 mg, with no statistically significant benefit in survival to discharge or neurological outcome. |
| Callaham, et al. [17] | 1992 | United States | OHCA | Non-Shockable, Shockable | Randomized Control Trial | Return of Spontaneous Circulation | 8% standard dose epi vs. 13% high dose epi (p-value = 0.01) | Hospital Admission, Survival to Hospital Discharge, Neurologic Outcome |
Hospital Admission: 10% standard dose vs. 18% high dose (p-value = 0.02) Survival to Hospital Discharge: 1.2% standard dose vs. 1.7% high dose (p-value = 0.83) Good Neurologic Outcome: 67% standard dose vs. 0% high dose (p-value = 0.45) |
High dose epinephrine (15 mg) compared to standard dose epinephrine was shown to improve the rate of ROSC and hospital admission, but not survival to hospital discharge or neurological outcome. |
| Dumas, et al. [11] | 2014 | France | OHCA | Non-Shockable, Shockable | Retrospective Cohort Study | Favorable Neurological Outcome—Dosage | 1 mg: 31.2% 1 mg epi vs. 60.5% no epi (aOR = 0.48; 95% CI, 0.27 to 0.84; p-value = 0.01) 2–5 mg: 17.7% 2–5 mg vs. 60.5% no epi (aOR = 0.30; 95% CI, 0.20 to 0.47) >5 mg: 12.0% >5 mg vs. 60.5% no epi (aOR = 0.23; 95% CI, 0.14 to 0.37) |
Favorable Neurological Outcome—Timing | 9 min: aOR = 0.54; 95% CI, 0.32 to 0.91 10 to 15 min: aOR: 0.33; 95% CI, 0.20 to 0.56 16 to 22 min: aOR= 0.23; 95% CI: 0.12 to 0.43 >22 min: aOR: 0.17; 95% CI: 0.09 to 0.34 |
Administration of epinephrine was negatively associated with favorable neurological outcomes, after adjusting for confounding variables, in a stepwise fashion |