Epinephrine use and cardiac arrest survival

Whist epinephrine (epinephrine) is commonly used during cardiopulmonary resuscitation, both in and out of hospital, its effectiveness is poorly established. Although some animal studies have suggested a short term benefit due to increased cerebral and coronary perfusion, an increase in myocardial oxygen consumption and ventricular arrhythmias has also been documented. The purpose of this analysis was to determine how the use of epinephrine in cardiopulmonary resuscitation performed before hospital arrival (out-of-hospital arrest) was associated with immediate and 1-month survival.

The study was a prospective, non-randomised, observational propensity analysis of data from 417 188 out-of-hospital cardiac arrests in Japan between 2005 and 2008. The main outcome measures were the return of spontaneous circulation before hospital arrival, survival at one month after cardiac arrest, survival with good or moderate cerebral performance, and survival with no, mild, or only moderate neurological disability. Outcomes were compared between those who were and were not administered epinephrine.

Return of spontaneous circulation before hospital arrival was observed in 2786 of 15 030 patients (18.5%) in the epinephrine group and 23 042 of 402 158 patients (5.7%) in the no-epinephrine group …