Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients

BACKGROUND Although epinephrine is essential for successful return of spontaneous circulation (ROSC), the influence of this drug on recovery during the post-cardiac arrest phase is debatable. OBJECTIVES This study sought to investigate the relationship between pre-hospital use of epinephrine and functional survival among patients with out-of-hospital cardiac arrest (OHCA) who achieved successful ROSC. RESULTS Of the 1,556 eligible patients, 1,134 (73%) received epinephrine; 194 (17%) of these patients had a good outcome versus 255 of 422 patients (63%) in the nontreated group (p 5 mg of epinephrine. Delayed administration of epinephrine was associated with worse outcome. CONCLUSIONS In this large cohort of patients who achieved ROSC, pre-hospital use of epinephrine was consistently associated with a lower chance of survival, an association that showed a dose effect and persisted despite post- resuscitation interventions. These findings suggest that additional studies to determine if and how epinephrine may provide long-term functional survival benefit are needed. (J Am Coll Cardiol 2014;64:2360-7) © 2014 by the American College of Cardiology Foundation.