The Controversies in Cardiopulmonary Resuscitation on High Dose Epinephrine Still Continue.
Goetting demonstrated the unprecedented survival of 8 out of 20 children who had failed to
respond to two doses of standard-dose therapy before receiving 0.2 mg of epinephrine per kg. (Ann.
Emerg. Med. 20:22, 91). In adults this has not resulted in increased survival, although there is an
increased return of spontaneous circulation. This may be due to the presence of coronary artery
disease (NEJM 327: 1045, 92). It is thought that epinephrine should be titrated to effect in resuscita
tion. Standard dose epinephrine (0.01-0.02 mg/kg) should be used initially and then escalated to 0.2
mg/kg if the standard dose is unsuccessful. This is an option in the new ACLS guidelines. JAMA
268:2271, 92.