ACLS And Epinephrine

Epinephrine in ACLS
  • Updated on: June 3, 2024

The medication, epinephrine, is of significant importance in ACLS.  Specific dosages of epinephrine are administered for managing critical cardiac emergencies. It acts by constricting blood vessels and improves blood flow to vital organs like the heart and brain in case of cardiac arrest. 

Healthcare professionals administer epinephrine intravenously or via endotracheal tube placement. Epinephrine is given at intervals of several minutes, with dosage adjustments based on patient response. In certain cases, infusion might be necessary. However, caution is exercised due to potential adverse effects. Let us understand and explore the concept of epinephrine ACLS through this blog.


What is the role of epinephrine in ACLS?

Epinephrine is a crucial component of ACLS (Advanced Cardiovascular Life Support) protocols. Let us understand the role it plays in ACLS:

Vasopressor Action:

Epinephrine acts as a potent vasopressor. It constricts blood vessels to improve blood flow to vital organs during cardiac arrest.


Enhancing Perfusion:

By enhancing coronary and cerebral perfusion, epinephrine helps maintain the supply of blood to the heart and brain.


Route of Administration:

Epinephrine is administered intravenously or via endotracheal tube placement because it ensures rapid and effective delivery.


Dosage Considerations:

Dosage adjustments are made based on patient response, with careful consideration to prevent adverse effects.


Continuous Monitoring:

Careful and regular monitoring is the key to ensuring that the benefits of epinephrine administration outweigh any potential risks.


What are the variations in epinephrine doses during ACLS?

During ACLS, epinephrine doses vary depending on the patient’s condition and response to treatment. Here’s a summary of the dosage as per the condition of the patient::

Patient Condition Dosage Interval
Cardiac Arrest 1 mg IV/IO Every 35 minutes
Bradycardia 210 mcg/min IV Titrate to effect
Hypotension/Shock 210 mcg/min IV Titrate to effect
Anaphylaxis 0.30.5 mg IM Single dose
Severe Asthma Exacerbation 0.30.5 mg IM Single dose
Stroke 0.01 mg/kg IM Single dose
Severe Allergic Reaction 0.30.5 mg IM Single dose

It is important to note that these intervals vary based on specific patient responses. 

Read: ACLS certification: What is it, and who needs it?

What is the recommended dosage of epinephrine in cardiac arrest?

The recommended dosage of epinephrine in cardiac arrest is 1 milligram. The dosage is administered intravenously every 3 to 5 minutes during Advanced Cardiovascular Life Support (ACLS) interventions. This dose helps stimulate the heart and improve blood flow to vital organs of the body. What is important to note is that dosages may vary based on specific protocols and patient response. Thus, it is important to be careful while administering the dosage to improve patient outcomes and minimize adverse effects. 


 How does the infusion dose of epinephrine (mcg/kg/min) vary during ACLS?

During ACLS, the infusion dose of epinephrine is measured in micrograms per kilogram per minute (mcg/kg/min). This varies from one patient to another. So, let us understand how the infusion dose of epinephrine varies:


 Initial Infusion Rate:

Initially, epinephrine is often administered at a rate of 2 to 10 mcg/kg/min to support circulation and enhance perfusion.


 Titration to Effect:

The infusion rate is titrated based on patient response, aiming to achieve adequate perfusion pressure while reducing adverse effects.


 Continued Monitoring:

Vigilant monitoring of vital signs and clinical status guides adjustments in infusion rate for better outcomes during ACLS interventions.


 What is the route of administration for epinephrine in ACLS protocols?


 Various routes of administration ensure rapid and effective delivery of epinephrine during cardiac emergencies in ACLS protocols.


Intravenous (IV) Administration:

Healthcare providers commonly administer epinephrine intravenously to achieve immediate systemic circulation through a peripheral or central venous line.


Intraosseous (IO) Administration:

When intravenous access is challenging, providers administer epinephrine via intraosseous access for rapid absorption and action.


Endotracheal Tube (ETT) Administration:

Although less preferable, providers can administer epinephrine via the endotracheal tube, which results in delayed absorption compared to IV or IO routes.


Read more: What are the H’s and T’s of ACLS?



Understanding epinephrine ACLS and its role is important to manage cardiac emergencies effectively. Each aspect is vital, whether its role as a vasopressor to dosage considerations and administration routes. Following recommended dosages and administration techniques leads to a timely and appropriate intervention. Thus, the role of epinephrine as a medication in ACLS protocols is crucial because it offers the best chances of survival and recovery in cardiac arrest situations.