For more than 40 years epinephrine has been a key agent used during cardiac arrest. Epinephrine is both an alpha-and beta-adrenergic agonist; therefore, it stimulates spon¬taneous cardiac contractions, increases systemic vascular resistance resulting in an increased aortic diastolic per-fusion pressure, and improves coronary blood flow. It is relevant that epinephrine constricts peripheral vessels but preserves flow to vital organs causing coronary artery dilation.
Epinephrine is indicated for fine VF, which is rendered more amenable to removal by countershock and for VF that does not respond to electrical countershock. Asystole and pulseless idioventricular rhythms and electromechani¬cal dissociation may respond to this drug, albeit rarely.
A dose of 1 mg IV push every 3–5 minutes (0.01 mg/kg) is recommended. A 20-ml IV fluid flush should be admi¬nistered to ensure delivery of the drug centrally. A dose of 1 mg/10 ml of a 1:10,000 solution may be given via the tracheobronchial tube.
A higher dose of epinephrine was advocated by the AHA in 1992 based on studies. If the 1-mg IV dose was ineffective, escalating doses of 3 and 5 mg or 5 mg per dose rather than 1 mg were advised; the result of 8 large randomized trials in patients with cardiac arrest however, showed no significant benefit. The higher dose regimen is no longer recommended.

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