High‐Dose versus Standard‐Dose Epinephrine Treatment of Cardiac Arrest after Failure of Standard Therapy

To assess the efficacy of high-dose epinephrine (HDE) compared with standard-dose epinephrine (SDE) in emergency department patients in cardiac arrest after SDE failed to improve asystole or ventricular fibrillation.Prospective, multicenter, blinded, controlled trial.Eight academic center emergency departments.One hundred forty patients treated for cardiac arrest.Primary outcomes were either improvement in cardiac rhythm or return of spontaneous circulation (ROSC). Of the 140 patients enrolled, 78 received HDE and 62 received SDE. Of the 34 patients with ventricular fibrillation, 3 were resuscitated with HDE and 2 with SDE (p = 0.60). Of those with asystole, ROSC occurred in 12 of HDE and 5 of SDE recipients (p = 0.11). No patient had return of significant neurologic function and none survived to hospital discharge. Overall, there was no advantage to HDE after failure of SDE.Our results are similar to those of controlled clinical trials comparing HDE with SDE in cardiac arrest.