Immediate Intravenous Epinephrine Versus Early Intravenous Epinephrine for In-Hospital Cardiopulmonary Arrest

Abstract Background intravenous epinephrine has been a key treatment for cardiopulmonary arrest since the early 1960s. Although, many studies have questioned neurological outcome benefit, it remains to be recommended in international guidelines for its benefit on return of spontaneous circulation (ROSC). The ideal timing for the first epinephrine dose is uncertain. We aimed to look at the association of immediate epinephrine administration (within 1-minute of cardiac arrest recognition) with return of spontaneous circulation (ROSC) up to 24-hours and beyond 24-hours. Methods this was a multicenter retrospective chart review of patients undergoing cardiopulmonary resuscitation. Descriptive statistics were used to characterize study population, while t-test and chi-square were used to compare groups and outcomes. Results immediate epinephrine administration (within 1-minute) is associated with higher rates of ROSC up to 24-hours (OR = 2.36, 95% CI; [1.46–3.81]) and beyond 24-hours (OR = 2.26, 95% CI; [1.06–4.83]). Conclusions we encourage immediate administration of epinephrine in conjunction with high-quality CPR, as this is associated with higher rates of ROSC.