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Epinephrine in Arrest – Sooner Is Better

January 19, 2017

Short Attention Span Summary

Epinephrine in arrest
There is debate over use of epi in arrest.  It seems to improve ROSC but not long-term survival.  This study found that patients in the no-epi group had decreased ROSC but higher percentage with favorable neurological outcome.  Patients who received epi had higher ROSC and lower percentage with favorable neurological outcome.  The gist of this study was that of patients who received epi, those who received it earlier in arrest, < 19 minutes, had improved odds of favorable neurological outcome compared to those who received it late.

Spoon Feed: If you’re going to use epi in arrest, sooner is better.  But not too soon.  Recall that epi given within 2 minutes of defibrillation of a shockable rhythm was associated with worse outcome.


Am J Emerg Med. 2016 Dec;34(12):2284-2290. doi: 10.1016/j.ajem.2016.08.026. Epub 2016 Aug 19.

Favorable neurological outcomes by early epinephrine administration within 19 minutes after EMS call for out-of-hospital cardiac arrest patients.

Tanaka H1, Takyu H2, Sagisaka R2, Ueta H2, Shirakawa T2, Kinoshi T3, Takahashi H3, Nakagawa T4, Shimazaki S2, Ong Eng Hock M5.

Author information:

1Department of EMS System, Graduate School, Kokushikan University, Tokyo 206-8515, Japan. Electronic address: hidetana@kokushikn.ac.jp.

2Department of EMS System, Graduate School, Kokushikan University, Tokyo 206-8515, Japan.

3Department of Sports Medicine, Kokushikan University, Tokyo 206-8515, Japan.

4Center for disaster medicine, Aichi Medical University, Nagakute 480-1195, Japan.

5Department of Emergency Medicine, Singapore General Hospital, Outram 169608, Singapore; Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, College Rd 169857, Singapore.



To evaluate the time-independent effect of the early administration of epinephrine (EPI) on favorable neurological outcome (as CPC [cerebral performance category] 1-2) at 1 month in patients with out-of-hospital cardiac arrest.


A total of 119 639 witnessed cardiac arrest patients from 2008 to 2012 were eligible for this nationwide, prospective, population-based observational study. Patients were divided into EPI group (n = 20 420) and non-EPI group (n = 99 219). To determine the time-dependent effects of EPI, EPI-administered patients were divided into 4 groups as follows: early EPI (5-18 min), intermediate EPI (19-23 min), late EPI (24-29 min), and very late EPI (30-62 min), respectively. Multiple logistic regression analyses and adjusted odds ratios (AORs) were determined for CPC 1-2 at 1 month (primary outcome) and field return of spontaneous circulation (as secondary outcome) among the groups.


The EPI and non-EPI group had identical background, but EPI group shows higher incidence public access defibrillation and emergency medical technician defibrillation delivered than the non-EPI group. The differences were clinically negligible. Higher return of spontaneous circulation rate (18.0%) and lower CPC 1-2 (2.9%) shown in the EPI group than in the non-EPI group (9.4% and 5.2%). In the time dependent analysis, CPC 1 to 2 was greatest in the early EPI group (AOR, 2.49; 95% confidence interval [CI], 1.90-3.27), followed by the intermediate EPI group (AOR, 1.53; 95% CI, 1.14-2.05) then the late EPI group (AOR, 0.71; 95% CI, 0.47-1.08) as reference.


Early EPI administration within 19 minutes after emergency medical service call independently improved the neurological outcome compared with late EPI (24-29 minutes) administration in patients with out-of-hospital cardiac arrest.

Copyright © 2016 Elsevier Inc. All rights reserved.

PMID: 27613359 [PubMed – in process]