Intramuscular epinephrine in cardiac arrest: A systematic review
Bibliographic record
Abstract
Background: Epinephrine administered by intravenous (IV) or intraosseous (IO) route is the first-line medication for cardiac arrest and is associated with improved survival. Intramuscular (IM) epinephrine is currently not indicated for cardiac arrest but may be faster and easier to administer and may result in improved patient outcomes. Aim: To evaluate the evidence for IM epinephrine compared to IV or IO epinephrine in, and animals with cardiac arrest. Methods: This systematic review followed the PRISMA guidelines and was registered in PROSPERO (CRD42021259729). Databases were searched for studies comparing IV, IO, and IM epinephrine administration in cardiac arrest up to June 2, 2025. Studies in children, adults, and animals with cardiac arrest were included. Studies involving neonates and unpublished studies (such as conference abstracts and trial protocols) were excluded. Two investigators reviewed studies for relevance, extracted data and assessed bias of individual studies using the ROBINS-I and OHAT tools. Certainty of evidence was evaluated using GRADE methodology. Results: One observational adult out-of-hospital cardiac arrest (OHCA) study, five animal studies, and one narrative review were included. For all studies, the risk of bias was moderate and certainty of evidence was low. In the one human before-and-after study of 1405 adults with OHCA, IM epinephrine was associated with improved survival (11.0 % vs 7.0 %; aOR 1.73, 95 % CI 1.10-2.71) and neurologically favourable survival (9.8 % vs 6.2 %; aOR, 1.72, 95 % CI 1.07-2.76) compared to IV/IO epinephrine. Animal studies in both adults and children had heterogeneous methods and results were mixed. Conclusion: A limited number of studies have compared IM epinephrine to IV/IO or no epinephrine in cardiac arrest, including one human trial which showed improved neurological survival for IM epinephrine. Further studies, particularly randomized controlled trials in humans, to explore IM epinephrine for cardiac arrest are justified.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.037 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.008 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".