A Comparison of Standard-Dose and High-Dose Epinephrine in Cardiac Arrest outside the Hospital

RECENT experimental studies of cardiac arrest have demonstrated that, as compared with standard doses of epinephrine (0.01 to 0.02 mg per kilogram of body weight), a larger dose (0.2 mg per kilogram) improves cerebral and myocardial blood flow, the balance between myocardial oxygen supply and demand, and rates of resuscitation. 1 2 3 4 5 6 7 As a result of these investigations, larger doses of epinephrine have been evaluated in several uncontrolled clinical trials. 8 9 10 11 12 These studies have found improvement in arterial diastolic pressure, 8 coronary perfusion pressure, 9 rates of resuscitation, 10 and neurologic outcome 11 , 12 with high doses of epinephrine. To compare the efficacy of high-dose epinephrine (0.2 mg . . .