Observational studyBMJ (Clinical research ed.)2016
Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis.
Observational study in BMJ (Clinical research ed.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
44 citing papers in PubMed, 3 syntheses or guidelines pooled it, 109 citations in OpenAlex.
- Therapeutic and adverse effects of adrenaline on patients who suffer out-of-hospital cardiac arrest: a systematic review and meta-analysis.European journal of medical research · 2023Pooled it
- Comparing Drugs for Out-of-hospital, Shock-refractory Cardiac Arrest: Systematic Review and Network Meta-analysis of Randomized Controlled Trials.The western journal of emergency medicine · 2021Pooled it
- Epinephrine in Out-of-hospital Cardiac Arrest: Helpful or Harmful?Chinese medical journal · 2017Pooled it
- Prediction of Shock-Refractory Ventricular Fibrillation During Resuscitation of Out-of-Hospital Cardiac Arrest.Circulation · 2023Trial
- Adrenaline to improve survival in out-of-hospital cardiac arrest: the PARAMEDIC2 RCT.Health technology assessment (Winchester, England) · 2021Trial
- The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial.Intensive care medicine · 2020Trial
- Effect of initial airway strategy on time to epinephrine administration in patients with out-of-hospital cardiac arrest.Resuscitation · 2019Trial
- Article
- Adding Purpose to Pulse: 2025 Pediatric Life Support Update.Indian pediatrics · 2026Review
- Adrenaline and return of spontaneous circulation during in-hospital cardiac arrest.Resuscitation plus · 2025Article
- Epinephrine Before Defibrillation in Children With Initially Shockable In-Hospital Cardiac Arrest.Critical care medicine · 2025Article
- Association of epinephrine and outcome in cardiac arrest with refractory shockable rhythm: a population-based, propensity-score matched analysis.Critical care (London, England) · 2025Article
- Reduced symptoms of anxiety among professional caregivers facing cardiac arrest after simulation based training.Scientific reports · 2025Article
- Use of Epinephrine in Cardiac Arrest: Advances and Future Challenges.Medicina (Kaunas, Lithuania) · 2024Review
- Article
- Association between defibrillation-to-adrenaline interval and short-term outcomes in patients with out-of-hospital cardiac arrest and an initial shockable rhythm.Resuscitation plus · 2024Article
- Hospital Variation in Epinephrine Administration Before Defibrillation for Cardiac Arrest Due to Shockable Rhythm.Critical care medicine · 2024Observational
- Article
- Outcomes of Cardiopulmonary Resuscitation in the Pediatric Intensive Care of a Tertiary Center.Journal of pediatric intensive care · 2023Article
- Comparison of paediatric basic life support guidelines endorsed by member councils of Resuscitation Council of Asia.Resuscitation plus · 2023Review
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 3 countries.
Funding
Abstract
objectivesTo evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population.
designProspective observational cohort study.
settingAnalysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States.
participantsAdults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation.
interventionEpinephrine given within two minutes after the first defibrillation.
main outcome measuresSurvival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were "at risk" of receiving epinephrine within the same minute but who did not receive it.
results2978 patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine administration was also associated with a decreased odds of return of spontaneous circulation (0.71, 0.60 to 0.83; P<0.001) and good functional outcome (0.69, 0.58 to 0.83; P<0.001).
conclusionHalf of patients with a persistent shockable rhythm received epinephrine within two minutes after the first defibrillation, contrary to current American Heart Association guidelines. The receipt of epinephrine within two minutes after the first defibrillation was associated with decreased odds of survival to hospital discharge as well as decreased odds of return of spontaneous circulation and survival to hospital discharge with a good functional outcome.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.