Central venous administration of epinephrine in out‐of‐hospital cardiac arrest: A propensity‐matched analysis

Abstract Background The association between central venous epinephrine administration and clinical outcomes in patients with out‐of‐hospital cardiac arrest (OHCA) is less certain. Objectives We compared clinical outcomes between patients who received epinephrine via a central venous catheter (CVC) and those who received via a peripheral intravenous catheter (PIVC). Methods This retrospective study included adults with nontraumatic OHCA who arrived at the emergency center between July 2022 and June 2025 in South Korea. Patients who received epinephrine via a midline catheter directly inserted into central veins under ultrasound guidance within 10 min of emergency department arrival were compared with those who received epinephrine via a PIVC. We performed 1:5 propensity score [PS] matching to balance the baseline characteristics. The primary outcome was sustained return of spontaneous circulation (ROSC), defined as ROSC > 20 min. Secondary outcomes included ROSC, survival to hospital admission, and survival to hospital discharge. Results Of the 659 enrolled patients, 58 received epinephrine via a CVC and 601 via a PIVC. After PS matching, 58 patients with CVCs were matched with 290 patients with PIVCs. Epinephrine administration via a CVC was associated with significantly higher odds of sustained ROSC (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.03–3.23, p = 0.040) and survival to hospital admission (OR 2.06, 95% CI 1.10–3.83, p = 0.023) compared with epinephrine administration through a PIVC. Conclusions In patients with OHCA, central venous epinephrine administration using ultrasound‐guided midline catheters placed in central veins is associated with improved rates of sustained ROSC and survival to hospital admission.