Optimal Timing for Epinephrine Administration in Out-of-Hospital Cardiac Arrest (OHCA)
Authors: Kenta Sakamoto, Hideto Yasuda, Yutaro Shinzato, Yuki Kishihara, Shunsuke Amagasa, Masahiro Kashiura, Takashi Moriya
Journal: Academic Emergency Medicine, 2025
Conclusions:
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Optimal Timing: Administering epinephrine within 10 minutes of EMS personnel contact is associated with favorable neurological outcomes and improved survival in OHCA patients with nonshockable rhythms.
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Clinical Implication: Emphasizes the need for early identification and intervention by EMS to maximize the benefits of epinephrine in OHCA care.
Methods:
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Design: Retrospective observational study.
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Data Source: Multicenter OHCA registry from 95 hospitals in Japan (June 2014–December 2020).
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Inclusion Criteria:
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Adult patients with OHCA.
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Nonshockable rhythms.
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Received epinephrine during resuscitation.
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Outcomes:
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Primary Outcome: Favorable 30-day neurological status (Cerebral Performance Category [CPC] 1 or 2).
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Secondary Outcome: 30-day survival.
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Analysis:
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Time from EMS contact to epinephrine administration categorized in 5-min intervals.
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Fine-Gray regression to calculate time-dependent propensity scores.
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Generalized estimating equation (GEE) to account for within-patient clustering.
Results:
Patient Cohort:
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Total Patients Analyzed: 36,756
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All patients had nonshockable rhythms and received epinephrine during resuscitation.
Key Findings:
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Neurological Outcomes:
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Epinephrine administration within 1-5 min significantly improved favorable 30-day neurological status (RR 9.36, 95% CI 1.19–73.7).
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Administration within 6-10 min also improved outcomes but to a lesser extent (RR 3.67, 95% CI 1.89–7.14).
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30-Day Survival:
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Survival benefits were observed with epinephrine administration at:
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1-5 min: RR 2.33 (95% CI 1.41–3.85).
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6-10 min: RR 2.09 (95% CI 1.65–2.65).
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11-15 min: RR 1.64 (95% CI 1.32–2.05).
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16-20 min: RR 1.70 (95% CI 1.29–2.25).
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Timing Insights:
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Earlier administration (within 10 min) was associated with the greatest improvement in both neurological outcomes and survival.
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Beyond 10 min, benefits diminished but remained statistically significant.
Sakamoto, K., Yasuda, H., Shinzato, Y., Kishihara, Y., Amagasa, S., Kashiura, M. and Moriya, T., Optimal timing for epinephrine administration in adult patients with out‐of‐hospital cardiac arrest: A retrospective observational study. Academic Emergency Medicine.