A retrospective multi-site cohort study investigated the use of push-dose epinephrine (PDE) in emergency departments (EDs) for managing hypotension in critically ill patients. Recognizing the limited ED-specific data compared to its established perioperative use, the study aimed to evaluate the utilization and dosing patterns of pre-filled epinephrine syringes (100 mcg/10 mL IV bolus) and determine the need for subsequent continuous vasopressor infusions.

The study analyzed data from 386 patients who received at least one dose of PDE between January 1, 2020, and December 31, 2021, collecting information on demographics, dosing, outcomes, and the need for continuous vasopressors. The findings revealed that the median age of the cohort was 69 years.

PDE was predominantly used in high-acuity cases (ESI Level 1 and 2). A total of 719 doses were administered, with a median dose of 20 mcg, and most patients received one or two doses.

A significant proportion, 70.2% of patients, required a continuous vasopressor infusion following PDE administration.

Patient outcomes included 81.9% admission to the intensive care unit and 15% mortality.

The study concluded that PDE is commonly used in EDs for older patients with high-acuity conditions, and the majority of these patients subsequently required continuous vasopressor support, suggesting PDE often acts as a bridge to infusion.

Further research is deemed necessary to ascertain if ready-made prefilled syringes impact adverse events and improve patient outcomes in the ED.

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