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Emergency care
Epinephrine should continue to be used in the treatment of out-of-hospital cardiac arrest
  1. Aqib Hafeez,
  2. Alex Novak
  1. Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Alex Novak, Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; alex.novak{at}

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EBM verdict

EBM Verdict on: Perkins GD, Ji C, Deakin CD, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Eng J Med 2018;379:711–21. doi: 10.1056/NEJMoa1806842.

  • Epinephrine standard dose (1 mg) should be used in out-of-hospital adult cardiac arrest as per current Advanced Life Support guidelines, however, resuscitation teams’ focus should be directed towards early defibrillation and high quality cardiopulmonary resuscitation where appropriate.

​Intravenous epinephrine has been a mainstay of resuscitation practice for many years, but evidence for its efficacy is scarce. The Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest trial included over 8000 patients randomised between intravenous epinephrine and placebo, demonstrating a small survival increase in the epinephrine group, but a statistically non-significant increase in severely adverse neurological outcomes.

Epinephrine has been firmly embedded in …

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  • Contributors Both AH and AN are free from conflicts of interest in the publication of this article and took equal part in the authorship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.