Factors Affecting Time to Epinephrine Administration During In-Hospital Cardiac Arrest

Tuesday, March 24, 2026

8:45 AM - 9:45 AM Central Time

Location: Connections Central - RST 11

Thomas Diaz, PharmD (he/him/his)

Johns Hopkins, Maryland

Disclosure(s): No relevant financial relationship(s) to disclose.
CS

Cole Swartz, PharmD

Pharmacist
The Johns Hopkins Hospital

Disclosure information not submitted.
SS

Stephanie Seto, PharmD, BCCCP

Pharmacist
Johns Hopkins Hospital

Disclosure information not submitted.
LM

LeAnn McNamara, PharmD, BCPPS

Pharmacist
The Johns Hopkins Hospital

Disclosure information not submitted.
JC

Jessica Crow, PharmD, MPH, BCCCP, FCCM

Pharmacist
The Johns Hopkins Hospital

Disclosure information not submitted.
HN

Heather Newton, MAS, RN

Clinical Data Abstractor
The Johns Hopkins Hospital

Disclosure information not submitted.
LF

Lynne Farrow, MSMS, BSN, RN

Simulation Educator
The Johns Hopkins Hospital

Disclosure information not submitted.
MT

Marida Twilley, MSN, RN, NPD-BC

Nurse Educator
The Johns Hopkins Hospital

Disclosure information not submitted.
BW

Bradford Winters, PhD, MD, FCCM

Physician
The Johns Hopkins Hospital

Disclosure information not submitted.
EH

Elizabeth Hunt, MD, MPH, PhD

Professor of Anesthesiology and Critical Care Medicine
Johns Hopkins University School of Medicine

Disclosure information not submitted.
JL

John Lindsley, PharmD, BCCP, BCCCP, AACC

Pharmacist
The Johns Hopkins Hospital

Disclosure information not submitted.

Introduction: Timely epinephrine administration during in-hospital cardiac arrest (IHCA) is recommended by the American Heart Association (AHA) and may impact quality of care and ultimate outcome of IHCA. This study sought to evaluate variability in time to initial epinephrine delivery during IHCA based upon patient and temporal factors.

Methods: This retrospective cohort study analyzed IHCA events in adult patients at an academic medical center from January 2014 through September 2024, using data from the institution’s internal AHA Get With The Guidelines-Resuscitation (GWTG-R) registry. Arrest events were included if the patient was at least 18 years of age and received intravenous or intraosseous epinephrine. Exclusions were visitors, hospital employees, patients with unknown arrest or epinephrine administration times, repeat arrest events within 60 minutes, and events occurring in outpatient buildings, procedural areas, or emergency department. The primary endpoint was number of events that epinephrine was administered within 5 minutes. The secondary endpoint was ROSC. Outcomes were analyzed using chi-square and logistic regression modeling.

Results: Of the 4,347 IHCA events from 2014-2020, 1,867 met inclusion criteria. Epinephrine was administered within 5 minutes in 1,688 (90.41%) events. Timely administration was significantly associated with proximity to the code team (p < 0.0001), patient illness category (p = 0.008), level of care (p < 0.001), and time of day (p < 0.0001). In a multivariable logistic regression analysis, events occurring farther from the code response team (OR = 2.50, 95% CI: 1.18-5.32), in non-monitored beds (OR = 4.62, 95% CI: 3.14-6.78), and during night shift (OR = 1.89, 95% CI: 1.35-2.63) had increased odds of delayed epinephrine administration greater than 5 minutes. Events occurring in patients classified as surgical illness category (OR 1.47, 95% CI: 1.18-1.83) and in monitored beds (OR 1.82, 95% CI: 1.33-2.49) had increased odds of ROSC.

Conclusions: Epinephrine administration within 5 minutes was achieved in over 90% of IHCA events. Greater odds of delayed administration were observed for events farther from the code team, in non-monitored beds, and during night shift. ROSC was higher among surgical patients and in monitored beds.