High-Dose Epinephrine in Adult Cardiac Arrest

SURVIVAL after cardiac arrest remains poor despite several decades of progress in advanced cardiac life support. 1 Outcomes are particularly bad for patients whose cardiac rhythm is asystole, electromechanical dissociation, or ventricular fibrillation resistant to multiple countershocks. 2 Epinephrine remains the first-line adrenergic agent for such patients, but few studies in humans have assessed the drug's effectiveness or the correct dosage in the treatment of cardiac arrest. The currently recommended dose of 1 mg for adults was derived from studies in dogs, 3 , 4 but it does not allow for the large difference in weight between dogs and humans. 5 Recent studies suggest increased myocardial . . .