What is the right dose of epinephrine?

Objective: To review the findings and discuss implications of studies on high-dose epinephrine (0.1 mg/kg) during cardiopulmonary resuscitation in children. Design: A critical appraisal of $A Comparison of High-Dose and Standard-Dose Epinephrine in Children with Cardiac Arrest$ by Perondi et al. (N Engl J Med 2004; 350:1722-1730), with literature review. Findings: Retrospective studies investigating the use of high-dose epinephrine during pediatric cardiopulmonary resuscitation demonstrate conflicting results with respect to return of spontaneous circulation and survival. The randomized controlled trial by Perondi et al. demonstrates decreased survival with the use of high-dose epinephrine and no difference in return of spontaneous circulation when compared with the standard dose. Conclusions: There is no benefit from the use of high-dose epinsphrine in pediatric cardiopulmonary resuscitation. There is potential harm from such dosing. The cumulative evidence against the use of high-dose epinephrine during pediatric cardiopulmonary resuscitation is strong.