During out-of-hospital cardiac arrest, the administration of epinephrine has potentially beneficial effects, such as augmenting coronary blood flow during CPR. However, its use can also lead to harmful effects, such as dysrhythmia. A placebo-controlled trial was undertaken to determine whether treatment with epinephrine is beneficial or harmful in patients experiencing out-of-hospital cardiac arrest.

In a multicenter, double-blind, randomized trial conducted by five ambulance services in the United Kingdom, paramedics administered advanced cardiac life support to adults experiencing out-of-hospital cardiac arrest. The 8,014 eligible patients were randomly assigned to receive either parenteral epinephrine or saline placebo. Patient characteristics in the two groups at baseline were similar, as were the concurrent treatments.

More patients in the epinephrine group had a return of spontaneous circulation and were transported to the hospital. In the epinephrine group, 3.2% of patients survived to 30 days, the primary outcome, compared with 2.4% of those in the placebo group. The proportion of patients who survived until hospital discharge with a favorable neurologic outcome wasn't significantly different in the two groups. The proportion of patients with severe neurologic impairment (a score of 4 or 5 on the modified Rankin Scale, which has a range of 0 [no symptoms] to 6 [death]), however, was higher in the epinephrine group than in the placebo group (31% versus 17.8%).

The authors note that in their previous work with patients, survival with a favorable neurologic outcome was identified as a higher priority than survival alone.

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