Epinephrine Use and Cardiac Arrest Survival

Whist epinephrine (adrenaline) is commonly used during cardiopulmonary resuscitation (CPR), 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 CPR performed before hospital arrival (out-of-hospital arrest) was associated with immediate and 1-month survival.

The study was a prospective, nonrandomised, 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 2,786 of 15,030 patients (18.5%) in the epinephrine group and 23,042 of 402,158 patients (5.7%) in the no-epinephrine group (P < .001); the difference remained significant in propensity-matched patients: 2446 (18.3%) vs. 1400 (10.5%) of 13,401 (P < .001).  However, both among all patients and propensity-matched patients, negative associations were observed between prehospital epinephrine and long-term outcome measures (adjusted ORs: 1-month survival, 0.46 [95% CI, 0.42-0.51]; CPC 1-2, 0.31 [95% CI, 0.26-0.36]; and OPC 1-2, 0.32 [95% CI, 0.27-0.38]; allP < .001).


Prehospital epinephrine administration following cardiac arrest was associated with an increased likelihood of the return of spontaneous circulation, but also with significantly poorer outcomes at one month.  This study therefore highlights the need for further research into how epinephrine is best used in the out-of-hospital arrest setting.

  • Hagihara A, Hasegawa M, Abe T, et al. Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA 2012; 307:1161-1168.
  • Callaway CW. Questioning the use of epinephrine to treat cardiac arrest. JAMA 2012; 307:1198-1200.



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