The dose of epinephrine during cardiopulmonary resuscitation in humans: what should it be?

The objective of vasopressor therapy during closed-chest cardiopulmonary resuscitation (CPR) is to augment coronary perfusion pressure so that spontaneous circulation can be reestablished. Epinephrine, an endogenous catecholamine with both alpha- and beta-adrenergic activity, is the vasopressor of choice for use during CPR. Epinephrine's potent alpha1-and alpha2-adrenergic effects improve cerebral and myocardial blood flow by preventing arterial collapse and by increasing peripheral vasoconstriction. The optimal dose of epinephrine in humans during closed-chest CPR is unknown. Studies suggest that the dose of epinephrine currently recommended during CPR may be five to ten times lower than the dose required to produce the beneficial pharmacologic effects observed in animal models of closed-chest CPR. Data from patients with prehospital cardiac arrest indicate that a 5-mg dose of epinephrine may be required to increase diastolic blood pressure above 30 mm Hg. Until additional data are available, our clinical experience suggests that all patients should receive at least one 1-mg dose of epinephrine. If the patient fails to respond, the administration of 3-5 mg of epinephrine every five minutes or the use of continuous infusions of epinephrine (0.2-0.6 mg/min) may be indicated.