Immediate Intravenous Epinephrine Versus Early Intravenous Epinephrine for Inhospital Cardiopulmonary Arrest

Abdullah Bakhsh; Maha Safhi; Ashwaq Alghamdi; Amjad Alharazi; Bedoor Alshabibi; Rajwa Alobaidi; Maryam Alnashri


BMC Anesthesiol. 2021;21(147) 

In This Article


A total of 589 charts from three different sites were screened (Figure 1). After-applying the exclusion criteria, only 360 patients were included for analysis. Table 1 shows the baseline characteristics of the patients. The median time to epinephrine administration was 2.00 min (IQR 3-min) and median CPR duration was 20:00 min (IQR 16:45 min). Sustained ROSC (20-min – 24-h) was achieved in 95 patients (26.40%).

Figure 1.

Inclusion and exclusion of patients' flowchart

Immediate (within 1-min) epinephrine administration was observed in 166 patients (46.10%), whereas early (≥2-min) epinephrine administration was seen in 144 patients (53.90%).

Our results reveal that the immediate administration of intravenous epinephrine is associated with statistically higher rates of ROSC (20-min – 24-h); 15.3% vs. 11.1% (p = 0.04).

A graphical illustration (Figure 2) shows a stepwise decrease in sustained ROSC (20-min – 24-h) with every 1-min delay in epinephrine administration: 18.90% showed sustained ROSC when receiving their first dose of epinephrine between 0 and 1 min. This was decreased to 4.40% when the first dose of epinephrine was received between 2 and 3 min, to 2.80% when epinephrine received between 4 and 5 min and down to 0.30% when the first dose was administered at 6-min or later (P < 0.01).

Figure 2.

Association Between Timing of First Dose of Epinephrine With Sustained Return of Spontaneous Circulation (≥20-min but < 24-h)

After adjusting for potential covariates, each minute delay in the administration of epinephrine was associated with 33% decrease in the odds of sustained ROSC (20-min – 24-h) (OR 1.33 95%CI [1.13–1.55]) (Table 2). Moreover, the same regression model showed that initial rhythm and airway placement had an independent effect on ROSC. Asystole was associated with lower odds of sustained ROSC (OR 1.96 95%CI [1.14–3.39]). Patients who did not get intubated during CPR were associated with higher odds of sustained ROSC (OR 0.50 95%CI [0.30–0.83]).