ArticleCritical care (London, England)2025
Association of epinephrine and outcome in cardiac arrest with refractory shockable rhythm: a population-based, propensity-score matched analysis.
Article in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Neurological outcomes after out-of-hospital cardiac arrest due to aneurysmal subarachnoid hemorrhage: a multicenter cohort study.Critical care (London, England) · 2026Article
- Kinemomics: spatiotemporal morphodynamic mapping of ventricular kinematic subpopulations in organotypic fetal heart slices.bioRxiv : the preprint server for biology · 2026Article
- Does epinephrine harm patients with out-of-hospital cardiac arrest with refractory shockable rhythm?Critical care (London, England) · 2026Article
- Kounis Syndrome Presenting with Atrial Fibrillation and Shark-Fin ST Elevation After Multiple Bee Stings in an African Patient: A Case Report.International medical case reports journal · 2026Article
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11 authors.
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Abstract
backgroundEpinephrine use in cardiac arrest is increasingly controversial, with contrasting results according to initial rhythm. We assessed the association between epinephrine use and favorable neurological outcome among patients with out of hospital cardiac arrest with refractory shockable arrest.
methodsIn this multicentric population-based prospective registry, we included all patients with out-of-hospital cardiac arrest, with persistent ventricular fibrillation after at least 3 defibrillations from 15/05/2011 to 31/12/2021 in Paris and its suburbs. Primary outcome was survival with a favorable neurological outcome (Cerebral Performance Categories level 1 or 2 at hospital discharge). A multivariate logistic regression analysis and a propensity score analysis with adjustment, matching and inverse probability weighting were performed.
resultsAmong the 3163 patients with refractory shockable arrest, 2572 (81%) received epinephrine. Primary outcome was achieved in 270 patients (11%) among those who received epinephrine, and in 294 patients (50%) among those who did not. After adjustment, epinephrine use remained negatively associated with favorable outcome (aOR 0.24, 95%CI 0.19-0.31, p < 0.001). This negative association between epinephrine and favorable outcome was consistent after adjustement for propensity-score (aOR 0.24, 95%CI 0.18-0.31, p < 0.001), matching on propensity score (aOR 0.40, 95%CI 0.31-0.51, p < 0.001), and in various sensitivity analyses.
conclusionIn a large population-based registry of patients experiencing refractory ventricular fibrillation, epinephrine use was consistently associated with worse outcome using various methodological approaches. These findings are challenging the systematic use of epinephrine in refractory ventricular fibrillation.The use of potential alternative therapeutic strategies might be evaluated in this population.
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