What dose of epinephrine is being used in pediatric resuscitation? Results of a survey

摘要

Standard-dose epinephrine (SDE) currently recommended by the American Heart Association for pediatric resuscitation is 0.01 mg/kg (0.1 ml/kg of 1colon;10,000 solution). SDE has come under increasing scrutiny; many authors suggest that this dose is too small. We sought to determine current epinephrine dosing practices among physicians practicing pediatric emergency medicine.Half of the members of the American Academy of Pediatrics Emergency Medicine section, selected randomly, were surveyed by a mailed questionnaire. After two mailings, 105 of 162 surveys (65percnt;) were completed by members in practiceOf the 105 responders, 59percnt; described their practice as ldquo;pediatric emergency medicinerdquo;; 17percnt; as ldquo;emergency medicine (children and adults)rdquo;; 10percnt; as ldquo;general pediatric practice or clinicrdquo;; 10percnt; as ldquo;critical carerdquo;; and 5percnt; as ldquo;other.rdquo; Fifty-one (49percnt;) had completed fellowship training, and 81 (77percnt;) were either PALS or APLS instructors (referred to as ldquo;instructorsrdquo; below).Overall, 72percnt; (76/105) indicated that they use doses larger than SDE. Sixty-five of these (86percnt;) described their dosing practice as ldquo;recommended dose initially, then larger dose.rdquo; Twenty-one percent use SDE less than half of the time, and 16percnt; use a dose 10 to 20 times larger at least half of the time. No responder used doses smaller than SDE. Instructors were more likely to use larger doses than were noninstructors (83percnt; compared with 38percnt;; P0.001). In the instructor group, a significantly larger dose was being taught ldquo;informallyrdquo; than ldquo;formallyrdquo; (P0.001).This survey was undertaken to determine current dosing practices by a group of physicians who are knowledgeable and experienced in pediatric resuscitation, not to resolve the question of the optimal dose of epinephrine. The use of doses larger than SDE is common practice within this group, and educators are teaching higher doses. This information may help to validate prospective studies comparing doses.