Acute cardiac care & resuscitation
Rhythm-specific association of epinephrine with outcomes in non-shockable cardiac arrest: a nationwide propensity-matched study
Main finding · Association between epinephrine and ROSC, by initial rhythmResult — go to the resultInteraction odds ratio 0.60 95% CI 0.51–0.68Authors' conclusion
The association between epinephrine and ROSC was greater in patients with asystole than in those with PEA, although a statistically significant association was observed in both groups.
Study context
- Population
- Adult out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythms registered between June 2014 and December 2021patients analysed · asystole 42,161 · pulseless electrical activity (PEA) 16,816
- Participants
- 58,977 patients
- Exposure
- whether the association between epinephrine and return of spontaneous circulation (ROSC) differs between patients with asystole and those with pulseless electrical activity (PEA)
- asystolen = 42,161
- PEAn = 16,816
Methodological detailsrisk-set matching using time-dependent propensity scores, registry-based (Japanese Association for Acute Medicine's Out-of-Hospital Cardiac Arrest registry)
- Risk-set matching using time-dependent propensity scores
- Registry-based (Japanese Association for Acute Medicine's Out-of-Hospital Cardiac Arrest registry)
Main finding
As reported in the abstract
Association between epinephrine and ROSC, by initial rhythm · 5 min after emergency medical service contact
Interaction odds ratio
0.60
95% CI 0.51–0.68
Asystole vs PEA
interaction odds ratio 0.60 (95% CI 0.51–0.68)
Observational data: associations, not effects.
Further findings
OR of epinephrine for ROSC (subgroup analyses) · 5 min after emergency medical service contact
| Population | OR (95% CI) | |
|---|---|---|
| Asystole | 1.81 (1.57-2.07) | |
| PEA | 1.43 (1.14-1.58) | |
| 0.512Odds ratio (log scale) |
30-day survival and favourable neurological outcomes at 30 days
- A similar trend was observed for 30-day survival
- No significant difference was found regarding favourable neurological outcomes at 30 days
Original publication
Rhythm-specific association of epinephrine with outcomes in non-shockable cardiac arrest: a nationwide propensity-matched study. Resuscitation. Published 30 April 2026. doi:10.
Summarised from the published abstract; every number is checked against it