Despite its central role in ACLS, the use of Epinephrine and outcome has been controversial. A major study finds “the use of epinephrine resulted in a significantly higher rate of 30-day survival than the use of placebo, but there was no significant between-group difference in the rate of a favorable neurologic outcome because more survivors had severe neurologic impairment in the epinephrine group”.
Postulated mechanisms include impairment of microvascular cerebral blood flow or possible reperfusion injury. So Epinephrine may improve survival but at a cost. The most important message to reiterate is how vital rapid CPR and defibrillation are.