Association of Timing of Epinephrine Administration With Outcomes in Adults With Out-of-Hospital Cardiac Arrest

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Abstract
Out-of-hospital cardiac arrest (OHCA) is a major public health problem with high mortality, affecting more than 350 000 individuals annually in the United States.1 Intravenous and intraosseous administration of epinephrine has been widely used for OHCA in the prehospital setting.2 In a recent randomized clinical trial, the use of epinephrine in adults with OHCA increased survival.3 However, evidence about the optimal timing of epinephrine administration is insufficient.4 The 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations5 and 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care6 recommend administration of epinephrine as soon as feasible for individuals with nonshockable cardiac rhythms (strong recommendation with a low certainty of evidence) and suggest administration of epinephrine after initial defibrillation attempts are unsuccessful for shockable cardiac rhythms (weak recommendation with low certainty of evidence). The low certainty of evidence for these recommendations suggests that the optimal timing of epinephrine administration is an existing knowledge gap.4

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