Epinephrine Dosing for Cardiac Arrest and Anaphylaxis

Cardiac Arrest Dosing

For newborns, the American Academy of Pediatrics recommends IV/IO epinephrine dosing of 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution) 1, 2
For newborns, the American Heart Association recommends ET tube epinephrine dosing of 0.05-0.1 mg/kg (0.5-1 mL/kg of 1:10,000 solution) if IV access is not available 1, 2, 3
The American Academy of Pediatrics recommends repeating epinephrine doses every 3-5 minutes as needed for newborns 2

The American Heart Association recommends IV/IO administration as the preferred route for cardiac arrest, providing faster and more reliable drug delivery compared to ET route 1, 3
The American Academy of Pediatrics recommends using 1:10,000 concentration (0.1 mg/mL) for cardiac arrest 2
Higher doses of epinephrine (>0.03 mg/kg) are not recommended due to increased risk of post-resuscitation mortality and cerebral blood flow interference, according to the American Heart Association 4
Endotracheal administration is only recommended if IV/IO access cannot be established, and requires higher doses (5-10 times IV dose) due to lower bioavailability, as stated by the American Heart Association 1, 3, 5

The American Heart Association warns against high-dose IV epinephrine, citing evidence of increased risk of mortality with high-dose IV epinephrine (0.1 mg/kg) 4, 6
The American Heart Association notes that ET administration limitations include significantly lower blood concentrations compared to IV administration 5, 6
Continuous monitoring is essential when administering IV epinephrine, according to the American College of Cardiology 7

The American College of Cardiology recommends diluting 0.1-0.3 mL of 1:1,000 epinephrine (1 mg/mL) in 10 mL of normal saline for push-dose epinephrine administration 7
The American College of Cardiology recommends administering push-dose epinephrine over several minutes with continuous monitoring 7
For pediatric patients, the American Academy of Pediatrics recommends using weight-based dosing of 0.01 mg/kg or 0.1 mL/kg of 1:10,000 solution for push-dose epinephrine administration 7