Adrenaline (Epinephrine) Dosage in Adult CPR
The recommended dose of epinephrine in adult cardiopulmonary resuscitation (CPR) is 1 mg IV/IO administered every 3-5 minutes throughout the resuscitation effort. 1, 2
Standard Dosing Protocol
- Initial dose: 1 mg IV/IO as soon as possible for non-shockable rhythms (asystole/PEA), or after the first shock for shockable rhythms (VF/pVT) if the rhythm remains shockable 2
- Subsequent doses: Continue with 1 mg IV/IO every 3-5 minutes throughout the resuscitation 1
- Route of administration: Intravenous (IV) or intraosseous (IO) is preferred 1
Administration Considerations
Timing of Administration
- For non-shockable rhythms (asystole/PEA): Administer epinephrine as soon as possible 2
- For shockable rhythms (VF/pVT): Administer after the first shock if the rhythm remains shockable 2
- Continue epinephrine administration every 3-5 minutes regardless of rhythm 1
Alternative Routes
If IV/IO access is not available:
- Endotracheal (ET) route can be used as a temporary alternative
- ET dose should be 2-2.5 times the IV dose (approximately 2-2.5 mg) 3
Evidence Supporting Current Recommendations
The 1 mg dose administered every 3-5 minutes has been the standard practice since the 1960s 4. This recommendation is supported by:
The 2020 American Heart Association (AHA) Guidelines for CPR and Emergency Cardiovascular Care, which explicitly states the epinephrine dose as 1 mg IV/IO every 3-5 minutes 1
Multiple clinical trials comparing standard-dose (1 mg) with high-dose epinephrine that found no significant difference in survival outcomes 3, 4
Common Pitfalls to Avoid
Avoid high-dose epinephrine: Despite earlier interest in higher doses (0.1-0.2 mg/kg), large clinical trials have shown no improvement in survival rates with high-dose regimens 3, 4
Don't delay epinephrine administration: For non-shockable rhythms particularly, early administration of epinephrine is critical 2
Don't administer repeated injections at the same site: This can cause tissue necrosis due to vasoconstriction 5
Don't interrupt chest compressions for drug administration: Maintain high-quality CPR with minimal interruptions while administering medications 1
Don't forget to consider reversible causes: While administering epinephrine, also consider and address potential reversible causes of cardiac arrest (Hypovolemia, Hypoxia, Hydrogen ion/acidosis, Hypo/hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis-pulmonary, Thrombosis-coronary) 1, 2
A recent systematic review and meta-analysis (2023) investigating the impact of epinephrine administration interval found that the current recommended interval of 3-5 minutes remains appropriate, as alternative intervals did not show significant improvements in outcomes 6.