A study led by Matthew Hansen, M.D., M.C.R., an assistant professor of emergency medicine in the OHSU School of Medicine showed that administering epinephrine via a prefilled epinephrine syringe designed for adults, can result in inaccurate dosing for pediatric patients. “This study raises questions about drug delivery systems designed for adults and used for children without rigorous testing of the accuracy in small doses,” said Hansen. (OHSU/Kristyna Wentz-Graff)

Epinephrine, also known as adrenaline, is a critical drug that, when injected, provides successful treatment of a number of medical conditions, including severe allergic reactions and certain respiratory infections. The drug also is used in hospitals and by emergency medical services providers to treat infants and children experiencing cardiac arrest. Recent studies, however, have shown that epinephrine can worsen outcomes for children who lose heart function when given at high doses.

A common method of administering epinephrine during cardiac arrest is through a commercially available prefilled epinephrine syringe. While these products are generally designed for adult use, providers may use the graduated lines on the syringe to conveniently measure and deliver proper amounts for pediatric injection. But according to Matthew Hansen, M.D., M.C.R., an assistant professor of emergency medicine in the OHSU School of Medicine, these products may actually yield higher doses than intended.

“This inaccuracy could lead to reduced survival for children suffering a cardiac arrest, a condition with high rates of death,” Hansen explained.

Hansen and his team analyzed 56 prefilled syringes by testing medication volume through weight and density. They determined that the average amount of epinephrine expelled by the syringe when the stopper was pushed to the 0.5 milliliter mark -- the recommended amount for an infant -- was 0.9 milliliters.

“This study raises questions about drug delivery systems designed for adults and used for children without rigorous testing of the accuracy in small doses,” said Hansen. “Until these delivery systems are updated, to ensure patient safety, practitioners should draw accurate doses of the drug from the prefilled products and transfer to a smaller syringe for infant dosing.”

This research published online today in JAMA Pediatrics.

This work is funded by the National Heart, Lung, and Blood Institute (grant number 5K12HL108974-03) and the National Institute of Child Health and Human Development (grant number 1R01HD062478-04).