one and done epi
This multi‑agency pre‑post study (five North Carolina EMS agencies) compared a single‑dose epinephrine protocol (one 1 mg IV/IO dose) to traditional multidose epinephrine (1 mg every 3–5 minutes) for adult non‑traumatic out‑of‑hospital cardiac arrest (OHCA) from 11/1/2016 to 10/31/2019. Primary outcome was survival to hospital discharge; secondary outcomes included return of spontaneous circulation (ROSC) and favorable neurologic outcome (CPC 1–2). Among 1,690 encounters (899 pre, 791 post), survival to discharge was similar between cohorts (~13.6% vs 15.4%, adjusted OR ~1.00, 95%CI 0.77–1.29) while ROSC was lower in the single‑dose cohort (42.3% vs 32.5% unadjusted; adjusted aOR 0.58, 95%CI 0.47–0.73). Favorable neurologic outcomes did not differ significantly. Authors conclude single‑dose epinephrine was associated with similar survival but decreased ROSC compared to multidose protocols.
Questions this document answers
11/1/2016 to 10/31/2019
1,690 encounters (899 pre‑implementation, 791 post‑implementation)
Survival to hospital discharge
Pulse present for ≥20 minutes without requiring additional chest compressions
aOR 0.58, 95%CI 0.47–0.73 (single‑dose associated with decreased ROSC)