It has been a very difficult time for Epi since last 5 years!
2011: Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial
2012: Prehospital Epinephrine Use and Survival Among Patients With Out-of-Hospital Cardiac Arrest
2014: Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients?
and now BMJ published in 2016: Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis.
This study shows that we are not compliant with ACLS guideline to give Epi in shockable rhythm. The guideline for shockable rhythm recommends 2min CPR then assessment of rhythm then continue CPR and first dose of EPI, but we give epi usually as soon as we insert the line. This approach will decreas odds of survival to hospital discharge , ROSC , and survival to hospital discharge with a good functional outcome.