Endobronchial application of high dose epinephrine in out of hospital cardiopulmonary resuscitation

Abstract

In a controlled prospective randomized study we compared the effect of high dose epinephrine versus the recommended standard dose in out of hospital cardiopulmonal resuscitation. Over a period of 3 years, the management and outcome of 57 resuscitations for cardiac arrest were completely documented in line with the recommendations of the ‘Utstein Style’ [1,2]. After endobronchial application of epinephrine in the standard initial dose of 2.5 mg, a return of spontaneous circulation (ROSC) was observed in eight of 14 cases (57%) with ventricular fibrillation (VF) and in six of 18 patients (33%) with asystole. The endobronchial application of high dose epinephrine with an initial dose of 5 mg resulted in a ROSC in nine of 15 patients with VF (60%) and in seven of ten patients with asystole (70%). Although the results are not significant (χ2-square test, asystole P=0.06), it would appear that high dose epinephrine has a beneficial effect on the outcome in asystolic patients.