- Although for profound prehospital hypotension, bolus-dose epinephrine (BDE) increases BP, potentially allowing time for resuscitative measures, mortality risk remains increased.
- Residual confounding is possible in this observational study, and controlled trials are needed.
Why this matters
- Some have advocated for BDE in this setting and some emergency services have adopted it, but results keep showing increased mortality risk.
- 35% of patients received BDE.
- Survival at 25 hours was 65% with BDE and 82% with controls (P<.001>
- Survival was also lower in the BDE group at discharge (43% vs 60%; P<.001 and at days vs p>
- BDE treatment was associated with increased systolic BP.
- Cases in the BDE group were not significantly more severe.
- Retrospective case-cohort study of 3302 critical care transport patients with severe hypotension (systolic BP,
- Funding: None disclosed.
- Residual confounding, selection and survival bias possible.