Authors: Hansen M et al. Circulation 2018 Mar 6.
Each 1-minute delay in epinephrine administration was associated with lower survival to hospital discharge.
Epinephrine is a standard part of cardiac arrest algorithms for patients with nonshockable rhythms and is given by emergency medical services (EMS) crews to patients who suffer out-of-hospital cardiac arrest (OHCA). These authors reviewed 2011–2015 data from the Resuscitation Outcomes Consortium to determine whether survival to hospital discharge is associated with time between EMS arrival and first epinephrine dose.
Roughly 32,000 patients with OHCA with initial nonshockable rhythms were included in the study. After controlling for confounders, the odds of survival to hospital discharge decreased by 4% for each additional 1-minute delay between EMS arrival and epinephrine administration (odds ratio, 0.96). Of patients who received epinephrine, 54% received it 10 or more minutes after EMS arrival, and, for this group, the odds of survival to hospital discharge were 18% lower than for patients who received epinephrine earlier (OR, 0.82).
Earlier epinephrine administration in OHCA might simply be a marker of better cardiac arrest care overall. However, these authors adjusted for EMS arrival time, bystander cardiopulmonary resuscitation, initial rhythm, and other confounders — and their results held up. These findings should remind all of us who treat patients with OHCA that early epinephrine, whether intravenous or intraosseous, should be administered immediately after high-quality chest compressions are begun.