Background Although current cardiopulmonary resuscitation guidelines recommend administering epinephrine at 3‐ to 5‐minute intervals during advanced life support (ALS), scientific evidence for the optimal dosing interval for enhancing hemodynamic parameters remains limited. Therefore, we compared the hemodynamic effects of 1‐, 3‐, and 5‐minute epinephrine dosing intervals on blood pressure augmentation in a porcine ventricular fibrillation cardiac arrest model. Methods Forty‐two pigs were randomly assigned to 1‐, 3‐, and 5‐minute epinephrine dosing‐interval groups. After ventricular fibrillation induction and a 2‐minute downtime, basic life support was initiated with a 30:2 compression‐to‐ventilation ratio for 8 minutes, followed by 30 minutes of ALS, including asynchronous ventilation at a rate of a single ventilation every 6 seconds, with oxygen delivered at 15 L/min. Epinephrine (0.02 mg/kg) was administered at predetermined intervals of 1, 3, or 5 minutes. We compared the pressure–time integrals for mean blood pressure, coronary perfusion pressure, and diastolic blood pressure among the groups over the 30‐minute ALS period. Results The mean blood pressure ( P <0.001), coronary perfusion pressure ( P =0.001), and diastolic blood pressure pressure–time integrals ( P =0.005) were significantly higher in the 1‐minute group than in the 3‐ and 5‐minute groups. Crucially, mean blood pressure and coronary perfusion pressure pressure–time integrals remained positive in the 1‐minute group but became negative in the 3‐ and 5‐minute groups during ALS. The diastolic blood pressure pressure–time integral also remained positive for a longer duration in the 1‐minute group. Conclusions A 1‐minute epinephrine dosing interval may be significantly more effective in augmenting blood pressure and critical hemodynamic parameters during ALS than are the currently recommended 3‐ or 5‐minute intervals.
Ahn et al. (2026) studied this question.