Successful resuscitation from cardiac arrest using high-dose epinephrine therapy. Report of two cases

A patient with cardiac arrest failed to respond to prolonged standard therapy for multiple dysrhythmias. High-dose intravenous epinephrine hydrochloride was administered 22 and 26 minutes after arrest. Coarsening of ventricular fibrillation and defibrillation with subsequent return of spontaneous circulation occurred. The patient was neurologically intact when eventually discharged. In another patient, prolonged asystole failed to respond to standard advanced cardiac life-support therapy. High-dose epinephrine was given 38 minutes after arrest, and return of spontaneous circulation subsequently occurred. Intensive treatment efforts were discontinued after admission to the hospital, and the patient died. The temporal sequence in these patients suggests that high-dose epinephrine therapy caused the return of spontaneous circulation. Recent studies suggest that presently recommended epinephrine doses may be too low, and investigation of graded epinephrine doses for the treatment of cardiac arrest is indicated. (JAMA1988;259:3031-3034)