Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

EMCrit Wee – Abandon Epinephrine?

Dr. Weingart has a mini wee podcast about the recent epinephrine research and whether EMS should be using epinephrine. Maybe the EMCrit logo is too big for a wee podcast.

One of the EMCrit listeners, the medical director for a major EMS agency, wanted to know what Dr. Weingart thinks about removing epinephrine from their cardiac arrest protocols.


EMCrit Wee – Abandon Epinephrine?


While Dr. Weingart thinks that the evidence will show that epinephrine is beneficial in cardiac arrest . . .

Well, you’ll have to listen to the podcast, all five and a half minutes of it, to find out the rest of his thoughts on this topic.

He recommends reading what Dr. Radecki (EM Literature of Note) wrote about epinephrine here.

I think that there may be only isolated indications for epinephrine. I do not think that we will ever know what those legitimate indications are until after we do a large enough well designed randomized controlled trial to separate out any benefit in survival.

ROSC (Return Of Spontaneous Circulation) is not a valid endpoint after 50 years of routine use, but the only evidence we have in humans is ROSC. We would not settle for such flimsy evidence in treating cancer (unless using alternative medicine), so why is it acceptable in cardiac arrest?

While we have not yet reached double digits on studies showing harm from epinephrine, there still is not a single study showing improved survival with epinephrine in cardiac arrest.

Millions of cardiac arrest patients treated with epinephrine, but we still cannot find any valid evidence of improved survival.

Vladimir and Estragon would have stopped waiting long ago.

Expert recommendations must come with an expiration date.


No exceptions.


If the expert recommendation is not followed by appropriate research, then the expert recommendation should not be treated better than the patients.

I completely agree with Dr. Weingart’s recommended approach. We should also study nitrates in cardiac arrest.


Go listen to all 5 and a half minutes of the podcast.




  1. I was reading a paper on pharmacology – one of the studied effects of Epi – constricting peripheral blood vessels. Last things I studied about the brain – there were no major vessels in the brain – big pipes feed it – and lots & lots of little vessels off them and through out. If that’s the case, we are vaso constricting the brain. Just a thought…