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May 27, 1988, Vol 259, No. 20 >
ARTICLE | May 27, 1988

Successful Resuscitation From Cardiac Arrest Using High-Dose Epinephrine Therapy: Title and subTitle BreakReport of Two Cases FREE

Eric M. Koscove, MD; Norman A. Paradis, MD
[+] Author Affiliations

Reprint requests to Department of Emergency Medicine, Los Angeles County—USC Medical Center, 1200 N State St, Los Angeles, CA 90033 (Dr Koscove).


JAMA. 1988;259(20):3031-3034. doi:10.1001/jama.1988.03720200053033
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References

A patient with cardiac arrest failed to respond to prolonged standard therapy for multiple dysrhythmias. High-dose intravenous epinephrine hydrochloride was administered 22 and 26 minutes after arrest. Coarsening of ventricular fibrillation and defibrillation with subsequent return of spontaneous circulation occurred. The patient was neurologically intact when eventually discharged. In another patient, prolonged asystole failed to respond to standard advanced cardiac life-support therapy. High-dose epinephrine was given 38 minutes after arrest, and return of spontaneous circulation subsequently occurred. Intensive treatment efforts were discontinued after admission to the hospital, and the patient died. The temporal sequence in these patients suggests that high-dose epinephrine therapy caused the return of spontaneous circulation. Recent studies suggest that presently recommended epinephrine doses may be too low, and investigation of graded epinephrine doses for the treatment of cardiac arrest is indicated.

(JAMA 1988;259:3031-3034)

REFERENCES

1 +
Crile GW:  Resuscitation of animals apparently dead. St Louis Med Surg J 1903;;84:299-302.
2 +
 Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA 1986;;255:2841-3044.
3 +
Brown CG, Werman HA, Davis EA, et al:  Comparative effect of graded doses of epinephrine on regional brain blood flow during CPR in a swine model. Ann Emerg Med 1986;;15:1138-1144.
4 +
Brown CG, Werman HA, Davis EA, et al:  The effects of graded doses of epinephrine on regional myocardial blood flow during cardiopulmonary resuscitation in swine. Circulation 1987;;75:491-497.
5 +
Ralston SH, Tacker WA, Showen L, et al:  Endotracheal versus intravenous epinephrine during electromechanical dissociation with CPR in dogs. Ann Emerg Med 1985;;14:1044-1048.
6 +
Kosnik JW, Jackson RE, Keats S, et al:  Dose-related response of centrally administered epinephrine on the change in aortic diastolic pressure during closed-chest massage in dogs. Ann Emerg Med 1985;;14:204-208.
7 +
Chambers W, Miles R, Stratbucker R:  Human chest resistance during successive countershocks, abstracted. Circulation 1977;;56( (suppl 3) ):183.
8 +
Tacker WA, Geddes LA:  The effects of disease and drugs on defibrillation , in Electrical Defibrillation . Boca Raton, Fla, CRC Press Inc, 1980;, p 164.
9 +
Redding JS, Pearson JW: Metabolic acidosis:  A factor in cardiac resuscitation. South Med J 1967;;60:926-932.
10 +
Mann DE, Inouye IK, Sakun S, et al:  Emergency defibrillation using a temporary pacing electrode catheter. PACE 1985;;8:753-756.
11 +
Bendixen HH, Laver MB, Flacke WE:  Influence of respiratory acidosis on circulatory effect of epinephrine in dogs. Circ Res 1963;;13:64-70.
12 +
Roberts JR, Greenberg MI, Baskin SI:  Endotracheal epinephrine in cardiorespiratory collapse. JACEP 1979;;8:515-519.
13 +
Greenberg MI:  Endotracheal drugs: State of the art. Ann Emerg Med 1984;;13(part 2):789-790.
14 +
Doan LA:  Peripheral versus central venous delivery of medications during CPR. Ann Emerg Med 1984;;13(part 2):784-786.
15 +
Otto CW, Yakaitis RW:  The role of epinephrine in CPR: A reappraisal. Ann Emerg Med 1984;;13(part 2):840-843.
16 +
Otto CW:  Cardiovascular pharmacology: II. The use of catecholamines, pressor agents, digitalis, and corticosteroids in CPR and emergency cardiac care. Circulation 1986;;74( (suppl 4) ):80-85.
17 +
Redding JS, Pearson JW:  Evaluation of drugs for cardiac resuscitation. Anesthesiology 1963;;24:203-207.
18 +
Redding JS, Pearson JW:  Resuscitation from ventricular fibrillation. JAMA 1968;;203:255-260.
19 +
Pearson JW, Redding JS:  The role of epinephrine in cardiac resuscitation. Anesth Analg 1963;;42:599-606.
20 +
McCarthy KC:  The problem of cardiac arrest. JAMA 1958;;168:2101-2103.
21 +
Otto CW, Yakaitis RW, Ewy GA:  Effect of epinephrine on defibrillation in ischemic ventricular fibrillation. Am J Emerg Med 1985;;3:285-291.
22 +
Michael JR, Guerci AD, Koehler RC, et al:  Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs. Circulation 1984;;69:822-835.
23 +
Todd GL, Baroldi G, Pieper GM, et al:  Experimental catecholamine-induced myocardial necrosis: I. Morphology, quantification and regional distribution of acute contraction band lesions. J Mol Cell Cardiol 1985;;17:317-338.

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1 +
Crile GW:  Resuscitation of animals apparently dead. St Louis Med Surg J 1903;;84:299-302.
2 +
 Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA 1986;;255:2841-3044.
3 +
Brown CG, Werman HA, Davis EA, et al:  Comparative effect of graded doses of epinephrine on regional brain blood flow during CPR in a swine model. Ann Emerg Med 1986;;15:1138-1144.
4 +
Brown CG, Werman HA, Davis EA, et al:  The effects of graded doses of epinephrine on regional myocardial blood flow during cardiopulmonary resuscitation in swine. Circulation 1987;;75:491-497.
5 +
Ralston SH, Tacker WA, Showen L, et al:  Endotracheal versus intravenous epinephrine during electromechanical dissociation with CPR in dogs. Ann Emerg Med 1985;;14:1044-1048.
6 +
Kosnik JW, Jackson RE, Keats S, et al:  Dose-related response of centrally administered epinephrine on the change in aortic diastolic pressure during closed-chest massage in dogs. Ann Emerg Med 1985;;14:204-208.
7 +
Chambers W, Miles R, Stratbucker R:  Human chest resistance during successive countershocks, abstracted. Circulation 1977;;56( (suppl 3) ):183.
8 +
Tacker WA, Geddes LA:  The effects of disease and drugs on defibrillation , in Electrical Defibrillation . Boca Raton, Fla, CRC Press Inc, 1980;, p 164.
9 +
Redding JS, Pearson JW: Metabolic acidosis:  A factor in cardiac resuscitation. South Med J 1967;;60:926-932.
10 +
Mann DE, Inouye IK, Sakun S, et al:  Emergency defibrillation using a temporary pacing electrode catheter. PACE 1985;;8:753-756.
11 +
Bendixen HH, Laver MB, Flacke WE:  Influence of respiratory acidosis on circulatory effect of epinephrine in dogs. Circ Res 1963;;13:64-70.
12 +
Roberts JR, Greenberg MI, Baskin SI:  Endotracheal epinephrine in cardiorespiratory collapse. JACEP 1979;;8:515-519.
13 +
Greenberg MI:  Endotracheal drugs: State of the art. Ann Emerg Med 1984;;13(part 2):789-790.
14 +
Doan LA:  Peripheral versus central venous delivery of medications during CPR. Ann Emerg Med 1984;;13(part 2):784-786.
15 +
Otto CW, Yakaitis RW:  The role of epinephrine in CPR: A reappraisal. Ann Emerg Med 1984;;13(part 2):840-843.
16 +
Otto CW:  Cardiovascular pharmacology: II. The use of catecholamines, pressor agents, digitalis, and corticosteroids in CPR and emergency cardiac care. Circulation 1986;;74( (suppl 4) ):80-85.
17 +
Redding JS, Pearson JW:  Evaluation of drugs for cardiac resuscitation. Anesthesiology 1963;;24:203-207.
18 +
Redding JS, Pearson JW:  Resuscitation from ventricular fibrillation. JAMA 1968;;203:255-260.
19 +
Pearson JW, Redding JS:  The role of epinephrine in cardiac resuscitation. Anesth Analg 1963;;42:599-606.
20 +
McCarthy KC:  The problem of cardiac arrest. JAMA 1958;;168:2101-2103.
21 +
Otto CW, Yakaitis RW, Ewy GA:  Effect of epinephrine on defibrillation in ischemic ventricular fibrillation. Am J Emerg Med 1985;;3:285-291.
22 +
Michael JR, Guerci AD, Koehler RC, et al:  Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs. Circulation 1984;;69:822-835.
23 +
Todd GL, Baroldi G, Pieper GM, et al:  Experimental catecholamine-induced myocardial necrosis: I. Morphology, quantification and regional distribution of acute contraction band lesions. J Mol Cell Cardiol 1985;;17:317-338.

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