The availability of 10 mg epinephrine vials for cardiac arrest: a retrospective analysis. The Belgian Cerebral Resuscitation Study Group.

The optimal dose of epinephrine in human cardiac arrest remains an area of continuing controversy. Apart from animal data some anecdotal reports in humans suggest that the dose currently recommended by the AHA may be insufficient for resuscitation of spontaneous circulation during prolonged cardiac arrest (CA). Since 1982, 1610 CA patients registered in Bruges have been evaluated under the following variables: prolonged survival (class 3 CPCR successes); solely restoration of spontaneous circulation (ROSC): class 2a, 2b and 3); epinephrine dose used during cardiopulmonary resuscitation (CPR); duration of advanced life support (ALS) and duration of complete CA. Because these variables affect the dose of epinephrine and each other simultaneously, we determined the partial correlation between outcome and epinephrine dose, independently of the other two variables (R12.34). Secondly we retrospectively assessed the effect of the availability of 10 mg epinephrine vials since March 1st, 1989 on outcome. Thus we made a separate assessment of the 114 patients registered after March 1st, 1989. The mean epinephrine dose (+/- S.E.M.) for the total population (n = 1724) was 2.53 +/- 0.06 mg; for patients since March 1989 (n = 114) this number was 5.58 +/- 0.36 mg. In contrast to the period before March 1989, we found a non-significant positive correlation between the survival of class 3 and epinephrine dose by limiting the influence of CPR times in the asystole and electromechanical dissociation (EMD) arrest groups.