Successful resuscitation from cardiac arrest using high-dose epinephrine therapy. Report of two cases
E. M. Koscove and N. A. Paradis
Department of Emergency Medicine, Los Angeles County-USC Medical Center 90033.
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.
