• Abdullah Bakhsh, Maha Safhi, Ashwaq Alghamdi, Amjad Alharazi, Bedoor Alshabibi, Rajwa Alobaidi, and Maryam Alnashri.
• Department of Emergency Medicine, the King Abdulaziz University, Jeddah, 80215, Saudi Arabia. aarbakhsh@kau.edu.sa.
• BMC Anesthesiol. 2021 May 13; 21 (1): 147.

BackgroundIntravenous epinephrine has been a key treatment in cardiopulmonary arrest since the early 1960s. The ideal timing for the first dose of epinephrinee is uncertain. We aimed to investigate the association of immediate epinephrine administration (within 1-min of recognition of cardiac arrest) with return of spontaneous circulation (ROSC) up to 24-h.MethodsThis was a multicenter retrospective analysis of patients who underwent cardiopulmonary resuscitation. We included the following patients: 1) ≥18 years-old, 2) non-shockable rhythms, 3) received intravenous epinephrine during cardiopulmonary resuscitation, 4) witnessed in-hospital arrest and 5) first resuscitation attempt (for patients requiring more than one resuscitation attempt). We excluded patients who suffered from traumatic arrest, were pregnant, had shockable rhythms, arrested in the operating room, with Do-Not-Resuscitate (DNR) order, and patient aged 17 years-old or less.ResultsA total of 360 patients were included in the analysis. Median age was 62 years old and median epinephrine administration time was two minutes. We found that immediate epinephrine administration (within 1-min) is associated with higher rates of ROSC up to 24-h (OR = 1.25, 95% CI; [1.01-1.56]), compared with early epinephrine (≥2-min) administration. After adjusting for confounding covariates, earlier administration of epinephrine predicted higher rates of ROSC sustained for up to 24-h (OR 1.33 95%CI [1.13-1.55]).ConclusionsImmediate administration of epinephrine in conjunction with high-quality CPR is associated with higher rates of ROSC.

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