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New research · Emergency Medicine
Emergency medicine journal : EMJ · 1w
Cohort studyEmergency medicine journal : EMJ · 2026

Association between the timing of prehospital epinephrine administration and patient outcomes after out-of-hospital cardiac arrest in Korea: a nationwide observational study.

Seung Hyo Lee, Won Pyo Hong, Jeong Ho Park … Young Su Kim
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Emergency MedicineCohort study

Epinephrine given over 20 minutes after cardiac arrest linked to worse brain recovery

Association between the timing of prehospital epinephrine administration and patient outcomes after out-of-hospital cardiac arrest in Korea: a nationwide observational study.

Seung Hyo Lee … Young Su Kim
Emergency medicine journal : EMJ · 2026
Background

The optimal timing of epinephrine during out-of-hospital cardiac arrest (out-of-hospital cardiac arrest) remains uncertain, particularly for neurological recovery.

Purpose

The optimal timing of epinephrine during out-of-hospital cardiac arrest (out-of-hospital cardiac arrest) remains uncertain, particularly for neurological recovery.

Methods

Were classified as early (≤20 min) or delayed (>20 min) based on arrest-to-first epinephrine.

n = 726 patients
Results

delayed epinephrine tied to lower odds of good brain recovery at hospital discharge

AOR by subgroup · 95% CI
null = 1
survival
0.56
likelihood of favourable neurological
0.56
odds of good CPC
0.96
f good CPC
0.83
marked drop beyond 30 min
0.05
More results

Among 10 726 patients, 3589 (33.5%) received epinephrine within 20 min.

More results

In continuous models, each 1-minute delay was associated with lower odds of good Cerebral Performance Category (aOR 0.964, 95% CI 0.942 to 0.987); a 5-minute delay corresponded to aOR 0.833 (95% CI 0.741 to 0.937) and bin-wise estimates showed a marked drop beyond 30 min (aOR 0.048, 95% CI 0.006 to 0.393).

“
Conclusion · 1 of 2

Early epinephrine administration within 20 min of cardiac arrest onset was associated with higher rates of ROSC, survival to discharge and favourable neurological recovery in this emergency medical service setting.

Conclusion · 2 of 2

These findings support the importance of timely advanced life support delivery, including early epinephrine, although cautious interpretation is warranted.

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