From the Guidelines
The dose of Epinephrine (Epi) in pediatric cardiac arrest is 0.01 mg/kg.
Key Points
- The preferred route of administration is intravenous (IV) or intraosseous (IO), as it is more effective than endotracheal (ETT) administration 1.
- The American Heart Association recommends an initial dose of 0.01 mg/kg of epinephrine for pediatric cardiac arrest, with no benefit shown for higher doses 1.
- High-dose epinephrine (0.1 mg/kg) may actually increase the risk of postresuscitation mortality and interfere with cerebral cortical blood flow and cardiac output 1.
- The evidence suggests that earlier administration of epinephrine, within 5 minutes of CPR initiation, is associated with improved outcomes, including increased rates of return of spontaneous circulation (ROSC) and survival to discharge 1.
- There is no evidence to support the use of sodium bicarbonate during cardiac arrest, except in special circumstances such as hyperkalemia 1.
From the Research
Dose and Concentration of Epinephrine in Pediatric Cardiac Arrest
- The standard dose of epinephrine for pediatric cardiac arrest is 0.01 mg/kg 2, 3.
- Some studies suggest that high-dose epinephrine (0.1-0.2 mg/kg) may be more effective in achieving return of spontaneous circulation (ROSC) and improving outcomes 2, 4.
- However, other studies have found no benefit or potential harm from using high-dose epinephrine in pediatric cardiopulmonary resuscitation 5.
- A survey of physicians practicing pediatric emergency medicine found that 72% use doses larger than the standard dose, with 16% using a dose 10-20 times larger at least half of the time 3.
- The American Heart Association recommends a standard dose of 0.01 mg/kg, but some studies suggest that this dose may be too small 2, 3.
Administration of Epinephrine
- Epinephrine can be administered intravenously (IV) or endotracheally (ET) 4.
- ET administration of epinephrine has been shown to be effective in achieving ROSC in a pediatric swine hypovolemic cardiac arrest model 4.
- The onset to ROSC was significantly shorter in the ET group compared to the IV group 4.
Physiologic Response to Epinephrine
- The change in diastolic blood pressure (DBP) following epinephrine administration during pediatric in-hospital CPR was associated with return of spontaneous circulation 6.
- Patients with a ≥ 5 mmHg increase in DBP were characterized as "responders" and had a higher rate of ROSC compared to non-responders 6.