Variabilities in the Use of IV Epinephrine in the Management of Cardiac Arrest Patients

Discussion
The results show a lack of standardization in epinephrine dosing across large EMS systems around the world, in spite of the existence of standard guidelines such as the 2015 AHA CPR and ECC Guidelines.5
Dosing maximums, epinephrine drip use, dosing amount and frequency, and dosing distinction for rhythms not being more consistent across the board shows the current state of uncertainty that epinephrine administration is in at this time.
The AHA ECC Guidelines don’t specify dosing maximums or about distinguish between v fib and other rhythms.5 In those two categories, responding agencies showed a lack of standardization, leading to questions about whether a maximum dose is necessary to ensure that epinephrine does more good than harm, and whether it should only be given in certain amounts in managing certain rhythms.
For dosing interval and aliquot, most agencies surveyed follow the ACLS guidelines of 1 mg every 3–5 minutes5; however, even within that group, there’s not a clear consensus on what’s the best dosing interval or amount.
In fact, due to some studies now showing epinephrine’s controversial effects in OHCA, some agencies have switched to dosing 0.5 mg at different time intervals instead of 1 mg.
Finally, although epi drips are recommended in the ACLS manual to correct post-ROSC hypotension,5 75% of responding agencies still reported not using them.
There’s an interesting link between the initial research on epinephrine use in cardiac arrest and ...

Source: JEMS Special Topics - October 15, 2018 Category: Emergency Medicine Authors: Nidhish Lokesh, NREMT Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news