Epinephrine is a cornerstone of medical cardiac arrest, but does it provide the same benefit in traumatic cardiac arrest (TCA)? Emerging research challenges long-held protocols, suggesting this go-to drug may not be the life-saver we assume it is—and could even cause harm. Host Bram Duffee, PhD, EMT-P, explores a groundbreaking study that could change how we manage these critical patients. This episode unpacks a February 2025 study in Prehospital Emergency Care that analyzed over 1,600 out-of-hospital trauma arrests. The findings were stark: epinephrine was linked to lower survival in blunt trauma and showed no clear benefit for penetrating injuries.
Lead researcher Dr. Cordelie Witt shares critical insights on why epinephrine may be counterproductive in TCA:
• Physiological Ceiling: Exogenous epinephrine may offer little benefit beyond the body's own sympathetic response to blood loss.
• Myocardial Oxygen Debt: It can increase the heart's oxygen demand when coronary blood flow is already minimal, potentially worsening cardiac function.
• Arrhythmia Risk: Epinephrine may induce arrhythmias in a heart already struggling.
• Worsening Hemorrhage: Raising blood pressure before controlling the source of bleeding may be counterproductive.
Watch the full interview with Dr. Witt to understand the science behind these findings. Don't forget to subscribe for more evidence-based discussions.
Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.
Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency / acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders. https://routledge.pub/Hypnotic-Communication-in-Emergency-Medical-Settings
Stay up to date: Review the most recent research in EMS through the monthly article reviews put out by the International PreHospital Medicine Institute https://iphmi.com/ems-articles-of-the-month
Connections: If you want to connect with the EMS Research Podcast staff check out our website at www.ProfessorBram.com If you enjoyed this episode please consider subscribing to EMS Research on YouTube: / @4emsresearch
Reference: Witt, C. E., Shatz, D. V., Robinson, B. R. H., Campion, E. M., Shapiro, M. L., Bui, E. H., Meizoso, J. P., & Dorlac, W. C. (2025). Epinephrine in prehospital traumatic cardiac arrest—Life saving or false hope? Prehospital Emergency Care, 1(1), 1–9.
