Acute cardiac care & resuscitationCohort study
Rhythm-specific association of epinephrine with outcomes in non-shockable cardiac arrest: a nationwide propensity-matched study
- nationwide propensity-matched study
- risk-set matching using time-dependent propensity scores
- registry-based (Japanese Association for Acute Medicine's Out-of-Hospital Cardiac Arrest registry)
Authors' 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 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
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
| Outcome | asystole | PEA |
|---|---|---|
| OR of epinephrine for ROSC (subgroup analyses) · 5 min after emergency medical service contact | 1.81 (95% CI 1.57–2.07) | 1.43 (95% CI 1.14–1.58) |
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:10.1016/j.resuscitation.2026.111116
Summarised from the published abstract; every number is checked against it