From the Guidelines
The push dose of epinephrine (Epi) is 0.01 mg/kg.
Epinephrine Dosing
- The dose of epinephrine is 0.01 mg/kg (0.1 mL/kg of the 1 mg/mL concentration), as stated in the 2018 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
- This dose can be repeated every 3-5 minutes if necessary.
- If no intravenous (IV) or intraosseous (IO) access is available, an endotracheal dose of 0.5 mg/kg (0.1 mL/kg of the 1 mg/mL concentration) can be given.
Clinical Context
- The push dose of epinephrine is typically used in emergency situations, such as cardiac arrest or anaphylaxis, to help restore cardiac function and improve blood pressure.
- It is essential to follow the recommended dosing guidelines to minimize the risk of adverse effects and ensure effective treatment.
- The 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care also provide information on the use of epinephrine, but the 2018 guidelines are more recent and take precedence 1.
From the Research
Push Dose of Epinephrine
- The push dose of epinephrine is typically administered as 10-20 µg of 1:100,000 epinephrine given intravenously every 2 minutes until the systolic blood pressure is at least 90 mmHg or the mean arterial pressure is 65 mmHg or greater 2
- A study found that push dose epinephrine may be an effective method of temporarily resolving hypotension during critical care transport, with a median increase in mean arterial pressure of 13.0 mmHg and a heart rate increase of 2.0 beats per minute 2
- The optimal weight-based epinephrine dose for return-of-spontaneous-circulation (ROSC) after a single bolus among patients with low likelihood of survival was found to be 0.013 mg/kg 3
- A simulation study compared the preparation and administration of push-dose versus continuous infusion epinephrine and found that push-dose had faster total preparation and administration time, but also had more major preparation and administration errors 4
Dosage Comparison
- Standard-dose epinephrine is currently recommended by the American Heart Association for pediatric resuscitation at 0.01 mg/kg (0.1 ml/kg of 1:10,000 solution) 5
- High-dose epinephrine has been studied in cardiac arrest patients, with doses ranging from 0.02 mg/kg to 0.2 mg/kg, but no significant difference in outcome was found between standard-dose and high-dose epinephrine 6