“More Nails In the Coffin For Epinephrine”

From Emergency Medicine Literature of Note:

The news for epinephrine in cardiac arrest keeps getting worse – it restarts the heart, but at what cost, and with what outcomes?

This is a study, published in JAMA, of 417,188 out-of-hospital cardiac arrest patients in Japan Рonly 15,030 of which received epinephrine during prehospital transport Рa far cry from the U.S., where the toolbox has typically already been emptied prior to the ED.  Nearly every baseline characteristic favored the epinephrine group Рmore witnessed arrests, more received bystander CPR, a physician was more frequently in the ambulance, more patients in ventricular fibrillation/PEA.  However, more of these patients also received an advanced airway, which has also been associated with worse outcomes.

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