Original Article
High-Dose Epinephrine in Adult Cardiac Arrest
N Engl J Med 1992; 327:1045-1050October 8, 1992
- Abstract
- Abstract
Background.
Recent studies suggest that doses of epinephrine of 0.1 mg per kilogram of body weight or higher may improve myocardial and cerebral blood flow as well as survival in cardiac arrest. Such studies have called into question the traditional dose of epinephrine (0.007 to 0.014 mg per kilogram) recommended for advanced cardiac life support.
Methods.
We randomly assigned 650 patients who had had cardiac arrest either in or outside the hospital to receive up to five doses of high-dose (7 mg) or standard-dose (1 mg) epinephrine at five-minute intervals according to standard protocols for advanced cardiac life support. Patients who collapsed outside the hospital received no advanced-life-support measures other than defibrillation before reaching the hospital.
Results.
There was no significant difference between the high-dose group (n = 317) and the standard-dose group (n = 333) in the proportions of patients who survived for one hour (18 percent vs. 23 percent, respectively) or who survived until hospital discharge (3 percent vs. 5 percent). Among the survivors, there was no significant difference in the proportions who remained in the best category of cerebral performance (90 percent vs. 94 percent) and no significant difference in the median Mini—Mental State score (36 vs. 37). The exploration of clinically important subgroups, including those with out-of-hospital arrest (n = 335) and those with in-hospital arrest (n = 315), failed to identify any patients who appeared to benefit from high-dose epinephrine and suggested that some patients may have worse outcomes after high-dose epinephrine.
Conclusions.
High-dose epinephrine was not found to improve survival or neurologic outcomes in adult victims of cardiac arrest. (N Engl J Med 1992;327:1045–50.)
Media in This Article
Table 1
Characteristics of the Study Patients.*Table 2
Survival of Patients in the High-Dose and Standard-Dose Groups.Article Activity
- Article
SURVIVAL after cardiac arrest remains poor despite several decades of progress in advanced cardiac life support.1 Outcomes are particularly bad for patients whose cardiac rhythm is asystole, electromechanical dissociation, or ventricular fibrillation resistant to multiple countershocks.2 Epinephrine remains the first-line adrenergic agent for such patients, but few studies in humans have assessed the drug's effectiveness or the correct dosage in the treatment of cardiac arrest. The currently recommended dose of 1 mg for adults was derived from studies in dogs,3 , 4 but it does not allow for the large difference in weight between dogs and humans.5
Recent studies suggest increased myocardial and cerebral blood flow and improved rates of survival in animals resuscitated with the use of much higher doses of epinephrine (0.07 to 0.2 mg per kilogram of body weight) than those currently recommended by the American Heart Association (0.007 to 0.014 mg per kilogram).6 7 8 9 10 In studies in humans, investigators have demonstrated substantially better hemodynamic responses to 5 to 14 mg of epinephrine than 1 mg.11 , 12 Clinicians have begun to use higher doses of epinephrine in their resuscitation efforts, and case reports indicate that survival may be improved.13 14 15 16
Commentators have addressed the issue of high-dose epinephrine in protocols for advanced cardiac life support, but have stressed the need for rigorously obtained data from randomized, controlled trials.17 18 19 20 Several small controlled trials have not shown improved survival with high-dose epinephrine, but they lacked the power to detect an important difference between groups.21 22 23 This study was designed to compare the effects of high-dose and standard-dose epinephrine on the survival of victims of cardiac arrest treated according to standard protocols for advanced cardiac life support.
Methods
Patients
Patients were considered eligible for the study if they were treated for cardiac arrest and required epinephrine according to standard protocols for advanced cardiac life support.1 Included were patients who had cardiac arrest either in or outside the Ottawa Civic Hospital or Ottawa General Hospital, both tertiary care institutions affiliated with the University of Ottawa Faculty of Medicine. Patients were excluded if they were under the age of 16 years, had a terminal illness, had not been given basic cardiopulmonary resuscitation (CPR) for more than 15 minutes, had acute trauma, had had a second cardiac arrest during the same hospital admission, or were in the operating or recovery rooms of the hospitals.
Informed consent was not obtained, because of the urgency of the situation and the unavailability of family members. The institutional review boards of the respective hospitals approved the research protocol. An independent data-monitoring committee assisted the investigators in ensuring the safety of the study.
Treatment Protocol
The treatment of patients followed standard protocols recommended by the American Heart Association for advanced cardiac life support; it was directed by senior medical residents on the wards and by staff physicians in the emergency departments.1 Patients who collapsed outside the hospital were brought to the emergency departments by emergency medical technicians trained to provide automatic defibrillation but not endotracheal intubation or intravenous therapy.
The patients were randomly assigned to receive either high-dose (7 mg) or standard-dose (1 mg) epinephrine at five-minute intervals to a maximum of five doses, according to standard protocols for advanced cardiac life support. Other than epinephrine dosage, no other changes were made to these protocols. Physicians who wished to administer more than five doses of epinephrine used standard 1-mg vials. Drugs were generally given intravenously by the peripheral, antecubital, or central route, but they were occasionally administered through the endotracheal tube when an intravenous catheter was not immediately available.
The study drugs were prepared by the pharmacy of the Ottawa Civic Hospital and were provided in packages of five coded and preloaded 10-ml syringes. The potency of the medication was determined by high-performance liquid chromatography. Study packages were available in special cardiac-arrest trays and boxes at 61 sites throughout the two hospitals. The distribution of packages was governed by a central randomization schedule for each hospital. The investigators had no control, however, over the order of use of the packages, which depended by chance on the location of each cardiac arrest.
Outcome Measures
All assessments were made in a double-blind fashion. Demographic and clinical data were obtained from a form completed by the physician responsible for the resuscitation and from the medical record. Body weights were recorded only if actual measurements were available; estimated weights were thought to be unreliable. The primary end point was successful resuscitation, defined as the return of a patient's pulse and blood pressure for at least one hour; such patients were usually stable enough to be admitted to the intensive care unit. In addition, patients were classified as having been discharged if they left the hospital alive. Neurologic function was assessed in all resuscitated patients according to the highest obtained score on the Glasgow Coma Scale (from 3, worst, to 15, best)24 and the rating at 96 hours on a five-point scale of cerebral performance (from grade 1, normal function, to grade 5, brain-dead).25 Patients who survived until hospital discharge were evaluated according to cerebral-performance category and their scores on a modified Mini—Mental State examination.26 Other outcomes assessed were the return of any detectable pulse during resuscitation, immediate blood-pressure response, and number of defibrillations required after the administration of epinephrine.
Statistical Analysis
Patients who did not meet the eligibility criteria, as determined by a blinded investigator, and who inappropriately received the study medication from the resuscitation team were excluded from the final analysis. An interim analysis of survival was performed by the data-monitoring committee after the accrual of each 125 patients, with the O'Brien—Fleming technique of grouped sequential analysis.27 The primary end point was initial resuscitation for at least one hour, and the chi-square analysis with Yates' correction was used to test the hypothesis that there was no difference between the two study groups. Similarly, chi-square analysis was used to test the hypothesis that there was no difference in survival until hospital discharge between the groups. All P values are two-tailed. Ninety-five percent confidence intervals were calculated for the absolute difference in survival rates between groups. Differences between groups for the neurologic outcomes — Glasgow Coma Scale score, cerebral-performance category, and modified Mini—Mental State score — were assessed with the Wilcoxon rank-sum test.28 Comparisons of patient and treatment characteristics were tested with chi-square, Fisher's exact28 or Student's t-test analyses, as appropriate. Survival outcomes in clinically important subgroups (based on the location of the arrest, initial rhythm at the time of advanced cardiac life support, time to receipt of epinephrine, cause of the arrest, and age) were compared with chi-square or Fisher's exact analyses, with the Bonferroni correction for multiple testing.29
Logistic-regression analysis30 was used to control for the possible confounding effects of variables related to survival, and the odds ratio for each survival outcome in each treatment group was estimated after adjustment for all the other variables included in the model. Adjustment was made for the following variables: age; sex; location of the arrest; times to CPR and advanced cardiac life support; witnessed or unwitnessed arrest; cause; rhythm; current or past medical diagnoses of circulatory disease, ischemic heart disease, or respiratory disease; and treatment group.
Results
During the study period, from December 18, 1989, to January 8, 1992, 788 cases of cardiac arrest were treated at the study sites in the two hospitals. Seventy-two patients were ineligible and were not randomized, and a further 21 patients (4 of whom were resuscitated) were eligible but did not receive the study medication, primarily owing to noncompliance by physicians. The need to make the study packages readily available at each site meant that some patients who did not meet the eligibility criteria were given the study medication by the resuscitation team. Thirty-three patients (19 in the high-dose group and 14 in the standard-dose group) received the study medication but were declared ineligible (by investigators who were blinded to treatment assignment) for the following reasons: trauma (16 patients), terminal illness (9), second arrest during same hospitalization (3), more than 15 minutes without CPR (2), respiratory arrest (2), and age younger than 16 years (1). Another 12 patients received the study medication inappropriately and could not be classified into one of the study groups because a mixture of dosages had been used; none of these patients survived. Six hundred fifty eligible patients received the study medication appropriately, and none were lost to follow-up.
The patients were predominantly male (64 percent), and their mean age was 66 years (range, 19 to 98). Fifty-two percent of the patients had cardiac arrest outside the hospital, 69 percent were witnessed, and three quarters were cardiac in origin. All demographic and medical characteristics were similar in the two groups, with the exception of a greater prevalence of past ischemic heart disease in the high-dose group (Table 1Table 1
Characteristics of the Study Patients.*). The mean times to CPR (4 minutes), advanced cardiac life support (11 minutes), and the administration of epinephrine (15 minutes) were not different between the two groups. The mean number of doses per patient was 2.5; on average, those in the high-dose group received 17.8 mg of epinephrine (0.10 mg per kilogram), and those in the standard-dose group received 2.5 mg (0.015 mg per kilogram).There was no difference in the proportions of resuscitated patients who survived at least one hour: 56 of 317 patients in the high-dose group and 76 of 333 patients in the standard-dose group (18 percent vs. 23 percent, P = 0.12) (Table 2Table 2
Survival of Patients in the High-Dose and Standard-Dose Groups.). The same results were obtained when the 33 patients deemed ineligible were included in the analysis. The 95 percent confidence interval of the observed 5 percent difference between the standard-dose and high-dose groups was -1 percent to 12 percent. Similarly, there was no difference in the proportions of patients discharged from the hospital: 10 of 317 in the high-dose group and 16 of the 333 in the standard-dose group (3 percent vs. 5 percent; P = 0.38; 95 percent confidence interval, -2 percent to 5 percent). After multivariate adjustment, the odds ratios in the high-dose group (as compared with the standard-dose group) were 0.71 (95 percent confidence interval, 0.47 to 1.09) for successful resuscitation and 0.73 (95 percent confidence interval, 0.32 to 1.69) for hospital discharge. The neurologic status of the survivors in both groups was generally good. Similar proportions of patients in the high-dose and standard-dose groups (90 percent vs. 94 percent, P = 0.24) remained in the best cerebral-performance category at discharge. Median Mini—Mental State scores were also very similar: 36 for the high-dose group (range, 33 to 40) and 37 for the standard-dose group (range, 33 to 40).Patients who were resuscitated but who did not survive until discharge had similar outcomes in the high-dose and standard-dose groups (median time to death, 25.5 vs. 32.5 hours [P = 0.22] and median best Glasgow Coma Scale score, 3 vs. 4 [P = 0.53]). Among these patients, the mean systolic and diastolic blood pressures and the mean heart rates were not different at one hour. Only four patients in the high-dose group and one in the standard-dose group had an immediate systolic blood pressure of more than 200 mm Hg. Among all the patients, the proportion who had any return of pulse was not significantly higher in the high-dose group than in the standard-dose group (38 percent vs. 32 percent, P = 0.15). Among the patients who presented in ventricular fibrillation or tachycardia, the mean number of defibrillations required after epinephrine treatment was not significantly higher in the high-dose group (4.1 vs. 3.2, P = 0.1).
In no clinically important subgroup of patients, including those with arrests in or outside the hospital, was survival at one hour or until hospital discharge better after receiving high-dose epinephrine (Table 3Table 3
Survival in Clinically Important Study Subgroups.). It is particularly noteworthy that the resuscitation rate was worse in the high-dose group among patients who received epinephrine more than 10 minutes after the onset of the arrest (11 percent, as compared with 24 percent among those who received epinephrine within 10 minutes after cardiac arrest; P = 0.004); this difference was significant after adjustment for multiple comparisons.Discussion
We found no improvement in survival, either immediate or longer term, in patients with cardiac arrest who were given high-dose epinephrine according to the usual protocols for advanced cardiac life support. In addition, neurologic outcomes in the survivors were no better in the recipients of high-dose epinephrine than in the recipients of standard-dose epinephrine. Further analysis of the data did not identify any subgroup of patients who benefited from high-dose epinephrine. Indeed, our results suggest that some patients given high-dose epinephrine may have had a worse outcome. Those who received their first dose of epinephrine more than 10 minutes after cardiac arrest had poorer rates of resuscitation. The cutoff point of 10 minutes was chosen on the basis of the approximate median time of receipt of epinephrine. Such observed subgroup effects need to be evaluated a priori in a new study. Patients who were resuscitated but who subsequently died in the hospital generally had severe neurologic impairment that was unresponsive to current intensive care management.
A large body of research supports the hypothesis that higher doses of epinephrine should improve survival in cardiac arrest. In animal models, the α1-adrenergic and α2-adrenergic activity of epinephrine causes systemic vasoconstriction without constricting coronary or cerebral blood vessels.31 32 33 Myocardial blood flow correlates with coronary perfusion pressure, which is the aortic diastolic pressure minus the right atrial pressure. Improvements in myocardial6 , 7 and cerebral8 , 34 blood flow are beneficial effects most prominently seen with dosages of epinephrine of 0.07 mg per kilogram or higher. Similarly, resuscitation of animals has been most effective at these higher dosages.3 , 4 , 9 , 10
In humans, physiologic data from victims of cardiac arrest indicate a graded hemodynamic dose response to epinephrine. Gonzalez and associates found that 5 mg, but not 1 mg, of epinephrine raised radial-artery diastolic blood pressures above 30 mm Hg.11 Paradis and associates demonstrated that 14 mg, but not 1 mg, of epinephrine improved coronary perfusion pressure,12 a measurement that correlates with the return of spontaneous circulation in animals and humans.35 Preliminary reports of case series13 14 15 and small clinical trials21 22 23 in adults have suggested better rates of resuscitation than expected after the use of high-dose epinephrine, but not necessarily improved survival. Goetting and Paradis, using historical controls, demonstrated the unprecedented survival of 8 of 20 children who had failed to respond to two doses of standard-dose therapy before receiving 0.2 mg of epinephrine per kilogram.16
Why did high-dose epinephrine fail to improve survival after cardiac arrest in our study? Our results are consistent with previous reports of an increased rate of return of spontaneous circulation, but they do not confirm expectations of better survival rates, either at one hour or at hospital discharge. Clearly, hemodynamic responsiveness to high-dose epinephrine has not been translated into a sustainable and stable cardiac rhythm that might allow more patients to be admitted to the hospital for intensive cerebral resuscitation or to be sent home from the hospital. Animal models involving healthy young dogs and swine may not adequately simulate the situation in older, diseased humans. Unlike the animals and children described in previous studies, the adults in our trial did not benefit from high-dose epinephrine, perhaps because of the presence of coronary artery disease. Kern and associates have demonstrated that during CPR myocardial blood flow below coronary lesions is substantially reduced and does not correlate well with coronary perfusion pressure.36
Our data raise the concern that high-dose epinephrine may actually be detrimental to certain subgroups of patients. Animal models have shown that the fibrillating heart rapidly consumes oxygen37 , 38 and that high-dose epinephrine may increase myocardial oxygen demand without increasing oxygen availability at the cellular level during resuscitation.39 40 41 Another mechanism of injury may be contraction-band necrosis, the characteristic pattern of myocardial damage caused by high concentrations of catecholamines, including epinephrine.42 Epinephrine has also been shown to lead to sustained ventricular arrhythmias43 and, during CPR, to induce ventilation—perfusion defects.44
Could specific features of the study design have resulted in a failure to identify a potentially beneficial effect of high-dose epinephrine? It is unlikely that a larger sample would have found better overall outcomes in the high-dose group. Ninety-five percent confidence intervals indicate that whereas absolute rates of resuscitation and discharge could have been as much as 12 and 5 percent better, respectively, for the standard-dose group, they could have been no more than 1 and 2 percent better for the high-dose group. In addition, our data did not indicate trends favoring high-dose epinephrine in any clinically important subgroups.
Perhaps an even larger dose of epinephrine or a different schedule of administration would have resulted in improved survival in the high-dose group. Our 7-mg dosage of epinephrine was based on a dose of 0.1 mg per kilogram in an average 70-kg patient and was representative of the dosages described in animals3 , 4 , 6 , 9 and in humans at the time the study was designed.11 , 13 Other studies have suggested that 0.2 mg per kilogram is an effective dose of epinephrine in resuscitation, although these studies did not directly compare 0.2 mg with our dose of 0.1 mg per kilogram.7 , 8 , 12 If a larger dose were likely to improve patient survival rather than simply effecting a brief return of pulse, we would have expected a trend favoring survival in the high-dose group in our study. The fact that many of our patients who survived and were ultimately discharged required more than a single dose of epinephrine (mean, 1.6 doses; range, 1 to 4) reinforces current recommendations to repeat epinephrine at least every five minutes in advanced cardiac life support. The effect of the route of administration cannot be clearly discerned, because many patients received the drug by more than one route. Only 7 patients in the high-dose group (2 percent) and 14 in the standard-dose group (4 percent) received the drug exclusively through the endotracheal tube; none of those in the high-dose group and 2 of those in the standard-dose group survived.
A particularly important group not directly studied by our design includes patients who have cardiac arrest outside the hospital and who receive full prehospital advanced cardiac life support from paramedics. Our out-of-hospital patients were defibrillated but did not receive full advanced cardiac life support until they reached the hospital, an average of 21 minutes after the arrest. This group, despite less prearrest morbidity, had much worse rates of survival than patients who had arrests in the hospital, because of the prolonged delays before treatment. Our multivariate models of survival did not identify the location of the arrest as a significant independent contributor to survival. We therefore believe that our findings may apply to patients who receive early epinephrine treatment outside the hospital, but this needs to be assessed in a separate study.
Our study did not demonstrate a beneficial effect of high-dose epinephrine on the survival or the neurologic outcome of adults with cardiac arrest. There was no subgroup of patients who did better with high-dose epinephrine, and certain groups may have had worse outcomes after such treatment.
Supported by a grant (03089R) from the Emergency Health Services Branch of the Ontario Ministry of Health. Dr. Stiell is a Career Scientist of the Health Research Personnel Development Program of the Ontario Ministry of Health.
We are indebted to David Moher (chairman), Robert Dales, Terry Klassen, and Jean-Francois Marquis, the members of the data-monitoring committee; to Katherine Vandemheen and Pamela Sheehan, the study coordinators; to pharmacists Ron Donnelly, Margaret Yen, and Michael Tierney; to Andreas Laupacis, Allan Jaffe, and Joseph Ornato for review of the manuscript; and to the physicians and nurses of the Ottawa Civic Hospital and Ottawa General Hospital for their patient cooperation with the study.
Source Information
From the Division of Emergency Medicine (I.G.S., B.N.W., J.A., G.E.D.), the Department of Medicine (P.C.H., G.A.W., L.A.J.H.), the Department of Epidemiology and Community Medicine (S.R.), and the Clinical Epidemiology Unit (R.M.S.), University of Ottawa, Ottawa, Ont., Canada. Address reprint requests to Dr. Stiell at the Clinical Epidemiology Unit, Ottawa Civic Hospital, 1053 Carling Ave., Ottawa, ON K1Y 4E9, Canada.
- References
References
1
Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) . JAMA 1986;255:2905–89.
CrossRef | Web of Science2
DeBard
CrossRef | Web of Science | Medline3
Pearson
CrossRef | Web of Science | Medline4
Redding
CrossRef | Web of Science | Medline5
Paradis
CrossRef | Web of Science | Medline6
Kosnik
CrossRef | Web of Science | Medline7
Brown
CrossRef | Web of Science | Medline8
Brown
CrossRef | Web of Science | Medline9
Otto
CrossRef | Web of Science | Medline10
Brunette
CrossRef | Web of Science | Medline11
Gonzalez
CrossRef | Web of Science | Medline12
Paradis
CrossRef | Web of Science | Medline13
Koscove
CrossRef | Web of Science | Medline14
Martin
CrossRef | Web of Science | Medline15
Callaham
CrossRef | Web of Science | Medline16
Goetting
CrossRef | Web of Science | Medline17
Callaham
CrossRef | Web of Science | Medline18
Ornato
CrossRef | Web of Science | Medline19
Brown
CrossRef | Web of Science | Medline20
Hebert
CrossRef | Medline21
Maha
CrossRef22
Lindner
CrossRef | Web of Science | Medline23
Sherman 24
Teasdale
CrossRef | Web of Science | Medline25
The Brain Resuscitation Clinical Trial II Study Group
CrossRef | Medline26
Teng
Web of Science | Medline27
O'Brien
CrossRef | Web of Science | Medline28
Zar JH. Biostatistical analysis. 2nd ed. Englewood Cliffs, N.J.: Prentice-Hall, 1984.
29
Fleiss JL. The design and analysis of clinical experiments. New York: John Wiley, 1986.
30
Hosmer DW Jr, Lemeshow S. Applied logistic regression. New York: John Wiley, 1989.
31
Pearson
CrossRef | Web of Science | Medline32
Schleien
CrossRef | Web of Science | Medline33
Michael
CrossRef | Web of Science | Medline34
Jackson
CrossRef | Web of Science | Medline35
Paradis
CrossRef | Web of Science | Medline36
Kern
CrossRef | Web of Science | Medline37
Monroe
Web of Science | Medline38
McKeever
Web of Science | Medline39
Livesay
Web of Science | Medline40
Ditchey
CrossRef | Web of Science | Medline41
Midei
CrossRef | Web of Science | Medline42
Baroldi
CrossRef | Web of Science | Medline43
Morady
CrossRef | Web of Science | Medline44
Tang
Web of Science | Medline
- Citing Articles (104)
Citing Articles
1
Kyung Woon Jeung, Hyun Ho Ryu, Kyung Hwan Song, Byung Kook Lee, Hyoung Youn Lee, Tag Heo, Yong Il Min. (2011) Reply to letter to “Improving ROSC with high dose of epinephrine. Are we really?”. Resuscitation
CrossRef2
Benjamin J. Lawner, Amal Mattu. 2011. Cardiac Arrest. , 123-137.
CrossRef3
Ian G. Jacobs, Judith C. Finn, George A. Jelinek, Harry F. Oxer, Peter L. Thompson. (2011) Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation 82:9, 1138-1143
CrossRef4
Kyung Woon Jeung, Hyun Ho Ryu, Kyung Hwan Song, Byung Kook Lee, Hyoung Youn Lee, Tag Heo, Yong Il Min. (2011) Variable effects of high-dose adrenaline relative to standard-dose adrenaline on resuscitation outcomes according to cardiac arrest duration. Resuscitation 82:7, 932-936
CrossRef5
Ankur A. Doshi, Clifton W. Callaway. 2011. The Post-Cardiac Arrest Patient. , 5-25.
CrossRef6
Jacques Lacroix, Paul Hébert, Dean Fergusson, Alan Tinmouth, Morris A. Blajchman, Jeannie Callum, Deborah Cook, John C. Marshall, Lauralyn McIntyre, Alexis F. Turgeon. (2011) The Age of Blood Evaluation (ABLE) Randomized Controlled Trial: Study Design. Transfusion Medicine Reviews 25:3, 197-205
CrossRef7
Tanner Boyd, William Brady. (2011) The “Code Drugs in Cardiac Arrest”—the use of cardioactive medications in cardiac arrest resuscitation. The American Journal of Emergency Medicine
CrossRef8
Jamie McElrath Schwartz, Eugenie S. Heitmiller, Elizabeth A. Hunt, Donald H. Shaffner. 2011. Cardiopulmonary Resuscitation. , 1200-1249.
CrossRef9
Adnan M. Bakar, Kenneth E. Remy, Charles L. Schleien. 2011. Physiologic Foundations of Cardiopulmonary Resuscitation. , 449-473.
CrossRef10
V. Wenzel, S.G. Russo, H.R. Arntz, J. Bahr, M.A. Baubin, B.W. Böttiger, B. Dirks, U. Kreimeier, M. Fries, C. Eich. (2010) Kommentar zu den Leitlinien 2010 zur kardiopulmonalen Reanimation des European Resuscitation Council. Der Anaesthesist 59:12, 1105-1123
CrossRef11
Shijie Sun, Wanchun Tang, Fengqing Song, Tao Yu, Giuseppe Ristagno, Yi Shan, Yinlun Weng, Max Harry Weil. (2010) The effects of epinephrine on outcomes of normothermic and therapeutic hypothermic cardiopulmonary resuscitation*. Critical Care Medicine 38:11, 2175-2180
CrossRef12
Charles D. Deakin, Laurie J. Morrison, Peter T. Morley, Clifton W. Callaway, Richard E. Kerber, Steven L. Kronick, Eric J. Lavonas, Mark S. Link, Robert W. Neumar, Charles W. Otto, Michael Parr, Michael Shuster, Kjetil Sunde, Mary Ann Peberdy, Wanchun Tang, Terry L. Vanden Hoek, Bernd W. Böttiger, Saul Drajer, Swee Han Lim, Jerry P. Nolan. (2010) Part 8: Advanced life support. Resuscitation 81:1, e93-e174
CrossRef13
Allan R. de Caen, Monica E. Kleinman, Leon Chameides, Dianne L. Atkins, Robert A. Berg, Marc D. Berg, Farhan Bhanji, Dominique Biarent, Robert Bingham, Ashraf H. Coovadia, Mary Fran Hazinski, Robert W. Hickey, Vinay M. Nadkarni, Amelia G. Reis, Antonio Rodriguez-Nunez, James Tibballs, Arno L. Zaritsky, David Zideman. (2010) Part 10: Paediatric basic and advanced life support. Resuscitation 81:1, e213-e259
CrossRef14
Giuseppe Ristagno, Simona Tantillo, Shijie Sun, Max Harry Weil, Wanchun Tang. (2010) Hypothermia improves ventricular myocyte contractility under conditions of normal perfusion and after an interval of ischemia. Resuscitation 81:7, 898-903
CrossRef15
Robert R Attaran, Gordon A Ewy. (2010) Epinephrine in resuscitation: curse or cure?. Future Cardiology 6:4, 473-482
CrossRef16
M. Baubin, B. Dirks, M. Holzer, V. Wenzel. (2009) ILCOR hot topics. Notfall + Rettungsmedizin 12:S2, 28-33
CrossRef17
Robert M. Sutton, Robert A. Berg, Mark A. Helfaer. (2009) Epinephrine for resuscitation from cardiac arrest: A double-edged sword?*. Critical Care Medicine 37:4, 1518-1520
CrossRef18
Andreas Neurauter, Jon Nysæther, Jo Kramer-Johansen, Joar Eilevstjønn, Peter Paal, Helge Myklebust, Volker Wenzel, Karl H. Lindner, Werner Schmölz, Morten Pytte, Petter A. Steen, Hans-Ulrich Strohmenger. (2009) Comparison of mechanical characteristics of the human and porcine chest during cardiopulmonary resuscitation. Resuscitation 80:4, 463-469
CrossRef19
Böttiger, Bernd W., Arntz, Hans-Richard, Chamberlain, Douglas A., Bluhmki, Erich, Belmans, Ann, Danays, Thierry, Carli, Pierre A., Adgey, Jennifer A., Bode, Christoph, Wenzel, Volker, . (2008) Thrombolysis during Resuscitation for Out-of-Hospital Cardiac Arrest. New England Journal of Medicine 359:25, 2651-2662
Full Text20
Giuseppe Ristagno, Tong Wang, Wanchun Tang, Shijie Sun, Carlos Castillo, Max Harry Weil. (2008) High-energy defibrillation impairs myocyte contractility and intracellular calcium dynamics. Critical Care Medicine 36:Suppl, S422-S427
CrossRef21
(2008) Vasopressors in Cardiopulmonary Resuscitation. New England Journal of Medicine 359:15, 1624-1625
Full Text22
Timothy J. Mader. (2008) Prolonged cardiac arrest: A revised model of porcine ventricular fibrillation. Resuscitation 76:3, 481-484
CrossRef23
Robert A. Berg, Vinay M. Nadkarni. 2008. Cardiopulmonary Resuscitation. , 275-281.
CrossRef24
Aaron E. Lottes, Ann E. Rundell, Leslie A. Geddes, Andre E. Kemeny, Michael P. Otlewski, Charles F. Babbs. (2007) Sustained abdominal compression during CPR raises coronary perfusion pressures as much as vasopressor drugs. Resuscitation 75:3, 515-524
CrossRef25
Charles F. Babbs. (2007) Statistical analysis of joint short-term and long-term survival in resuscitation research. Resuscitation 75:2, 323-331
CrossRef26
T. Palmaers, S. Albrecht, C. Leuthold, F. Heuser, J. Schuettler, B. Schmitz. (2007) Post-resuscitation haemodynamics in a novel acute myocardial infarction cardiac arrest model in the pig. European Journal of Anaesthesiology 24:7, 580-588
CrossRef27
Peter E. Penson, William R. Ford, Kenneth J. Broadley. (2007) Vasopressors for cardiopulmonary resuscitation. Pharmacology & Therapeutics 115:1, 37-55
CrossRef28
Mary Bennett, Niranjan Kissoon. (2007) Is Cardiopulmonary Resuscitation Warranted in Children Who Suffer Cardiac Arrest Post Trauma?. Pediatric Emergency Care 23:4, 267-272
CrossRef29
Xiangshao Fang, Wanchun Tang, Shijie Sun, Max Harry Weil. (2006) ??-Opioid???induced pharmacologic myocardial hibernation during cardiopulmonary resuscitation. Critical Care Medicine 34:Suppl, S486-S489
CrossRef30
William E Dager, Cynthia A Sanoski, Barbara S Wiggins, James E Tisdale. (2006) Pharmacotherapy Considerations in Advanced Cardiac Life Support. Pharmacotherapy 26:12, 1703-1729
CrossRef31
Xiangshao Fang, Wanchun Tang, Shijie Sun, Lei Huang, Zitong Huang, Max Harry Weil. (2006) Mechanism by which activation of ??-opioid receptor reduces the severity of postresuscitation myocardial dysfunction. Critical Care Medicine 34:10, 2607-2612
CrossRef32
V. Wenzel, S. Russo, H. R. Arntz, J. Bahr, M. A. Baubin, B. W. Böttiger, B. Dirks, V. Dörges, C. Eich, M. Fischer, B. Wolcke, S. Schwab, W. G. Voelckel, H. W. Gervais. (2006) Die neuen Reanimationsleitlinien 2005 des European Resuscitation Council. Der Anaesthesist 55:9, 958-979
CrossRef33
(2006) Adult advanced life support: Australian Resuscitation Council Guidelines 2006. Emergency Medicine Australasia 18:4, 337-356
CrossRef34
Gianluca Cammarata, Max Harry Weil, Peter Csapoczi, Shijie Sun, Wanchun Tang. (2006) Challenging the rationale of three sequential shocks for defibrillation. Resuscitation 69:1, 23-27
CrossRef35
Ricardo A. Samson, Marc D. Berg, Robert A. Berg. (2006) Cardiopulmonary resuscitation algorithms, defibrillation and optimized ventilation during resuscitation. Current Opinion in Anaesthesiology 19:2, 146-156
CrossRef36
R. Blaine Easley, Charles L. Schleien, Donald H. Shaffner. 2006. Pediatric Cardiopulmonary Resuscitation. , 1110-1154.
CrossRef37
Mahesh Sharman, Kathleen L. Meert. (2005) What is the right dose of epinephrine?. Pediatric Critical Care Medicine 6:5, 592-594
CrossRef38
Martin von Planta. (2005) Scientific Basis of Cardio-Pulmonary Resuscitation, an Evidence-Based Review. Heart Drug 5:4, 205-213
CrossRef39
Francis X. Guyette, Guy E. Guimond, David Hostler, Clifton W. Callaway. (2004) Vasopressin administered with epinephrine is associated with a return of a pulse in out-of-hospital cardiac arrest. Resuscitation 63:3, 277-282
CrossRef40
G Nichol, E Huszti, J Rokosh, A Dumbrell, J McGowan, L Becker. (2004) Impact of informed consent requirements on cardiac arrest research in the United States: exception from consent or from research?. Resuscitation 62:1, 3-23
CrossRef41
Robert A Berg, Fred W Chapman, Marc D Berg, Ronald W Hilwig, Isabelle Banville, Robert G Walker, Richard C Nova, Duane Sherrill, Karl B Kern. (2004) Attenuated adult biphasic shocks compared with weight-based monophasic shocks in a swine model of prolonged pediatric ventricular fibrillation. Resuscitation 61:2, 189-197
CrossRef42
Perondi, Maria Beatriz M., Reis, Amelia G., Paiva, Edison F., Nadkarni, Vinay M., Berg, Robert A., . (2004) A Comparison of High-Dose and Standard-Dose Epinephrine in Children with Cardiac Arrest. New England Journal of Medicine 350:17, 1722-1730
Full Text43
Jinglan Wang, Max Harry Weil, Takashi Kamohara, Wanchun Tang, Shijie Sun, Kada Klouche, Joe Bisera. (2004) A lazaroid mitigates postresuscitation myocardial dysfunction. Critical Care Medicine 32:2, 553-558
CrossRef44
M MORRIS, V NADKARNI. (2003) Pediatric cardiopulmonary-cerebral resuscitation: an overview and future directions. Critical Care Clinics 19:3, 337-364
CrossRef45
John M. Field. (2003) Update on cardiac resuscitation for sudden death: International Guidelines 2000 on Resuscitation and Emergency Cardiac Care. Current Opinion in Cardiology 18:1, 14-25
CrossRef46
Robert E. O'Connor, Joseph P. Ornato, Jane Wigginton, Richard C. Hunt, Gregory Mears, Joe Penner. (2003) A LTERNATIVE C ARDIOPULMONARY R ESUSCITATION D EVICES. Prehospital Emergency Care 7:1, 31-41
CrossRef47
Mikael Holmberg, Stig Holmberg, Johan Herlitz. (2002) Low chance of survival among patients requiring adrenaline (epinephrine) or intubation after out-of-hospital cardiac arrest in Sweden. Resuscitation 54:1, 37-45
CrossRef48
Samuel J. Stratton, James T. Niemann. (2002) Reconsideration of proximate Utstein-style end points. Critical Care Medicine 30:Supplement, S137-S139
CrossRef49
Jacobo Wortsman. (2002) Role of epinephrine in acute stress. Endocrinology & Metabolism Clinics of North America 31:1, 79-106
CrossRef50
Michael R. Sayre, Marianne Gausche-Hill. (2002) Conducting Randomized Trials in the Prehospital Setting. Prehospital Emergency Care 6:s2, S38-S47
CrossRef51
Jean-Luc Hanouz, Sylvain Thuaudet, Michel Ramakers, Alain Bessodes, Pierre Charbonneau, Jean-Louis Gérard, Henri Bricard. (2002) Insertion of the minimally invasive direct cardiac massage device (MIDCM): training on human cadavers. Resuscitation 52:1, 49-53
CrossRef52
(2002) The National EMS Research Agenda Writing Team. Prehospital Emergency Care 6:s3, 1-43
CrossRef53
James T. Niemann, Samuel J Stratton. (2001) The Utstein template and the effect of in-hospital decisions: the impact of do-not-attempt resuscitation status on survival to discharge statistics. Resuscitation 51:3, 233-237
CrossRef54
Mark G. Angelos, James J. Menegazzi, Clifton W. Callaway. (2001) Bench to Bedside Resuscitation from Prolonged Ventricular Fibrillation. Academic Emergency Medicine 8:9, 909-924
CrossRef55
Rolf Gedeborg, Hans C:son Silander, Sten Rubertsson, Lars Wiklund. (2001) Cerebral ischaemia in experimental cardiopulmonary resuscitation — comparison of epinephrine and aortic occlusion. Resuscitation 50:3, 319-329
CrossRef56
Ian G Stiell, Paul C Hébert, George A Wells, Katherine L Vandemheen, Anthony SL Tang, Lyall AJ Higginson, Jonathan F Dreyer, Catherine Clement, Erica Battram, Irene Watpool, Sharon Mason, Terry Klassen, Brian N Weitzman. (2001) Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial. The Lancet 358:9276, 105-109
CrossRef57
Niranjan Kissoon. (2001) Child with absent vital signs. The Indian Journal of Pediatrics 68:3, 273-278
CrossRef58
Armand R.J. Girbes. (2000) Rational use of vasoactive drugs after cardiac resuscitation: focus on inotropic agents. Resuscitation 47:3, 339-342
CrossRef59
Ronald W. Hilwig, Karl B. Kern, Robert A. Berg, Arthur B. Sanders, Charles W. Otto, Gordon A. Ewy. (2000) Catecholamines in cardiac arrest: role of alpha agonists, beta-adrenergic blockers and high-dose epinephrine. Resuscitation 47:2, 203-208
CrossRef60
J MANNING, L KATZ. (2000) CARDIOPULMONARY AND CEREBRAL RESUSCITATION. Critical Care Clinics 16:4, 659-679
CrossRef61
C. Vandycke, P. Martens. (2000) High dose versus standard dose epinephrine in cardiac arrest — a meta-analysis. Resuscitation 45:3, 161-166
CrossRef62
(2000) Part 6: Advanced Cardiovascular Life Support. Resuscitation 46:1-3, 155-162
CrossRef63
Daniel DeBehnke. (2000) The Effects of Graded Doses of Endothelin-1 on Coronary Perfusion Pressure and Vital Organ Blood Flow during Cardiac Arrest. Academic Emergency Medicine 7:3, 211-221
CrossRef64
Gordon A Ewy, Joseph P Ornato. (2000) Emergency cardiac care: introduction. Journal of the American College of Cardiology 35:4, 825-880
CrossRef65
Volker Wenzel, Karl H. Lindner, Anette C. Krismer, Wolfgang G. Voelckel, Michael F. Schocke, Wolfgang Hund, Markus Witkiewicz, Egfried A. Miller, Günter Klima, Jörg Wissel, Werner Lingnau, Franz T. Aichner. (2000) Survival with full neurologic recovery and no cerebral pathology after prolonged cardiopulmonary resuscitation with vasopressin in pigs. Journal of the American College of Cardiology 35:2, 527-533
CrossRef66
(2000) Amiodarone in Out-of-Hospital Cardiac Arrest. New England Journal of Medicine 342:3, 216-217
Full Text67
R.G Mitchell, U.M Guly, T.H Rainer, C.E Robertson. (2000) Paramedic activities, drug administration and survival from out of hospital cardiac arrest. Resuscitation 43:2, 95-100
CrossRef68
James J. Menegazzi, David C. Seaberg, Donald M. Yealy, Eric A. Davis, Bruce A. MacLeod. (2000) C OMBINATION P HARMACOTHERAPY WITH D ELAYED C OUNTERSHOCK VS S TANDARD A DVANCED C ARDIAC L IFE S UPPORT A FTER P ROLONGED V ENTRICULAR F IBRILLATION. Prehospital Emergency Care 4:1, 31-37
CrossRef69
Gad Bar-Joseph, Tuvia Weinberger, Shlomo Ben-Haim. (2000) Response to repeated equal doses of epinephrine during cardiopulmonary resuscitation in dogs. Annals of Emergency Medicine 35:1, 3-10
CrossRef70
Wanchun Tang, Max Harry Weil, Shijie Sun, Hitoshi Yamaguchi, Heitor P Povoas, Andreja Marn Pernat, Joe Bisera. (1999) The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function. Journal of the American College of Cardiology 34:3, 815-822
CrossRef71
Sardar Ijlal Babar, Robert A. Berg, Ronald W. Hilwig, Karl B. Kern, Gordon A. Ewy. (1999) Vasopressin versus epinephrine during cardiopulmonary resuscitation: a randomized swine outcome study. Resuscitation 41:2, 185-192
CrossRef72
(1999) Epinephrine for Out-of-Hospital Cardiac Arrest. New England Journal of Medicine 340:22, 1763-1765
Full Text73
Rolf Gedeborg, Sten Rubertsson, Lars Wiklund. (1999) Improved haemodynamics and restoration of spontaneous circulation with constant aortic occlusion during experimental cardiopulmonary resuscitation. Resuscitation 40:3, 171-180
CrossRef74
Paul E Sirbaugh, Paul E Pepe, Joan E Shook, Kay T Kimball, Mitchell J Goldman, Mark A Ward, Denise M Mann. (1999) A Prospective, Population-Based Study of the Demographics, Epidemiology, Management, and Outcome of Out-of-Hospital Pediatric Cardiopulmonary Arrest. Annals of Emergency Medicine 33:2, 174-184
CrossRef75
Graham Nichol, Ian G. Stiell, Paul Hebert, George A. Wells, Kathy Vandemheen, Andreas Laupacis. (1999) What Is the Quality of Life for Survivors of Cardiac Arrest? A Prospective Study. Academic Emergency Medicine 6:2, 95-102
CrossRef76
Gueugniaud, Pierre-Yves, Mols, Pierre, Goldstein, Patrick, Pham, Emmanuel, Dubien, Pierre-Yves, Deweerdt, Carine, Vergnion, Michel, Petit, Paul, Carli, Pierre, . (1998) A Comparison of Repeated High Doses and Repeated Standard Doses of Epinephrine for Cardiac Arrest Outside the Hospital. New England Journal of Medicine 339:22, 1595-1601
Full Text77
Carl van Walraven, Ian G Stiell, George A Wells, Paul C Hébert, Katherine Vandemheen. (1998) Do Advanced Cardiac Life Support Drugs Increase Resuscitation Rates From In-Hospital Cardiac Arrest?. Annals of Emergency Medicine 32:5, 544-553
CrossRef78
Colin Robertson (UK), Petter Steen (Norway), Jennifer Adgey (UK), Leo Bossaert (Belgium), Pierre Carli (France), Douglas Chamberlain (UK), Wolfgang Dick (Germany), Lars Ekstrom (Sweden), Svein A Hapnes (Norway), Stig Holmberg (Sweden), Rudolph Juchems (Germany), Fulvio Kette (Italy), Rudy Koster (Netherlands), Francisco J de Latorre (Spain), Karl Lindner (Austria), Narcisco Perales (Spain). (1998) The 1998 European Resuscitation Council guidelines for adult advanced life support. Resuscitation 37:2, 81-90
CrossRef79
Joseph Varon, Paul E Marik, Robert E Fromm. (1998) Cardiopulmonary resuscitation: a review for clinicians. Resuscitation 36:2, 133-145
CrossRef80
Daniel M Fatovich, David A Prentice, Geoffrey J Dobb. (1997) Magnesium in cardiac arrest (the magic trial). Resuscitation 35:3, 237-241
CrossRef81
KEITH G. LURIE, KARL H. UNDNER. (1997) Recent Advances in Cardiopulmonary Resuscitation. Journal of Cardiovascular Electrophysiology 8:5, 584-600
CrossRef82
V. Nadkarni, M.F. Hazinski, D. Zideman, J. Kattwinkel, L. Quan, R. Bingham, A. Zaritsky, J. Bland, E. Kramer, J. Tiballs. (1997) Paediatric life support. Resuscitation 34:2, 115-127
CrossRef83
Karl H Lindner, Burkhard Dirks, Hans-Ulrich Strohmenger, Andreas W Prengel, Ingrid M Lindner, Keith G Lurie. (1997) Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. The Lancet 349:9051, 535-537
CrossRef84
Charles Brown, Lars Wiklund, Gad Bar-Joseph, Brian Miller, Nicholas Bircher, Norman Paradis, James Menegazzi, Martin von Planta, George C. Kramer, Sven-Erik Gisvold. (1996) Future directions for resuscitation research. IV. Innovative advanced life support pharmacology. Resuscitation 33:2, 163-177
CrossRef85
A.H.amed H. Idris, L.A.nce B. Becker, Joseph P. Ornato, J.E.rris R. Hedges, Nicholas G. Bircher, Nisha C. Chandra, Richard O. Cummins, Wolfgang Dick, Uwe Ebmeyer, H.E.nry R. Halperin, M.A.ry Fran Hazinski, Richard E. Kerber, Karl B. Kern, P.E.ter Safar, P.E.tter A. Steen, M.Michael Swindle, Joshua E. Tsitlik, Irene von Planta, M.A.rtin von Planta, R.O.bert L. Wears, M.A.x H. Weil. (1996) Utstein-style guidelines for uniform reporting of laboratory CPR research.. Resuscitation 33:1, 69-84
CrossRef86
Joseph P. Ornato, Norman Paradis, Nicholas Bircher, Charles Brown, Herman DeLooz, Wolfgang Dick, William Kaye, Robert Levine, Paul Martens, Robert Neumar, Rita Patel, Paul Pepe, Sivam Ramanathan, Sten Rubertsson, Richard Traystman, Martin von Planta, Vyacheslav Vostrikov, Max Harry Weil. (1996) Future directions for resuscitation research. III. External cardiopulmonary resuscitation advanced life support. Resuscitation 32:2, 139-158
CrossRef87
Nicholas Bircher, Charles Otto, Charles Babbs, Allan Braslow, Ahmed Idris, Jean-Peter Keil, William Kaye, John Lane, Tohru Morioka, Wolfgang Roese, Lars Wik. (1996) Future directions for resuscitation research. II. External cardiopulmonary resuscitation basic life support. Resuscitation 32:1, 63-75
CrossRef88
Carin M. Olson, Kathleen A. Jobe. (1996) Reporting approval by research ethics committees and subjects' consent in human resuscitation research. Resuscitation 31:3, 255-263
CrossRef89
Norman A. Paradis. (1996) Cardiac arrest research in humans — insights into failure. Resuscitation 31:2, 93-100
CrossRef90
C HOOK, K KOCH. (1996) ETHICS OF RESUSCITATION. Critical Care Clinics 12:1, 135-148
CrossRef91
Bernd Schmitz, Matthias Fischer, Kurt Bockhorst, Mathias Hoehn-Berlage, Konstantin-Alexander Hossmann. (1995) Resuscitation from cardiac arrest in cats: influence of epinephrine dosage on brain recovery. Resuscitation 30:3, 251-262
CrossRef92
S.P. Woodhouse, S. Cox, P. Boyd, C. Case, M. Weber. (1995) High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest. Resuscitation 30:3, 243-249
CrossRef93
Kelly J. Tucker, James L. Larson, Ahamed Idris, Anne B. Curtis. (1995) Advanced cardiac life support: Update on recent guidelines and a look at the future. Clinical Cardiology 18:9, 497-504
CrossRef94
Robert W. Neumar, Nicholas G. Bircher, Ka Ming Sim, Fung Xiao, Kathy Swales Zadach, Ann Radovsky, Laurence Katz, Ewe Ebmeyer, Peter Safar. (1995) Epinephrine and sodium bicarbonate during CPR following asphyxial cardiac arrest in rats. Resuscitation 29:3, 249-263
CrossRef95
W Meadow, J Katznelson, T Rosen, J Lantos. (1995) Putting futility to use in the NICU: ethical implications of non-survival after CPR in very low-birth-weight infants. Acta Paediatrica 84:6, 589-592
CrossRef96
Jon E. Tyson. (1995) Use of unproven therapies in clinical practice and research: How can we better serve our patients and their families?. Seminars in Perinatology 19:2, 98-111
CrossRef97
Michael E. Boczar, Mark A. Howard, Emanuel P. Rivers, Gerard B. Martin, H. Mathilda Horst, Christopher Lewandowski, Michael C. Tomlanovich, Richard M. Nowak. (1995) A technique revisited. Critical Care Medicine 23:3, 498-503
CrossRef98
Catherine Choux, Pierre-Yves Gueugniaud, Alain Barbieux, Emmanuel Pham, Claude Lae, Pierre-Yves Dubien, Paul Petit. (1995) Standard doses versus repeated high doses of epinephrine in cardiac arrest outside the hospital. Resuscitation 29:1, 3-9
CrossRef99
Keith G. Lurie. (1994) Active compression-decompression CPR: a progress report. Resuscitation 28:2, 115-122
CrossRef100
Kelly J. Tucker, Frank Galli, Michael A. Savitt, Daniel Kahsai, Laura Bresnahan, Rita F. Redberg. (1994) Active compression-decompression resuscitation: Effect on resuscitation success after in-hospital cardiac arrest. Journal of the American College of Cardiology 24:1, 201-209
CrossRef101
Charles M. Little, Charles G. Brown. (1993) Angiotensin II improves myocardial blood flow in cardiac arrest. Resuscitation 26:2, 203-210
CrossRef102
Alan Gilston. (1993) CPR and high dose epinephrine. Resuscitation 25:3, 283-284
CrossRef103
Alan Gilston. (1993) Fifteen minutes and cardiac arrest. Resuscitation 25:2, 181-182
CrossRef104
(1993) High-Dose Epinephrine in Cardiopulmonary Resuscitation. New England Journal of Medicine 328:10, 735-736
Full Text
