10/30/2025
You're working a pediatric cardiac arrest, and IV/IO access is proving tough. What if you could give that first dose of epinephrine faster, without vascular access?
Now, if this sounds familiar, it's because Dr. Scott Youngquist's group in Salt Lake City published a paper which showed a survival benefit with IM Epi in OHCA.
His data prompted this study we review below, which asks "Can IM epinephrine via autoinjector speed up that first life-saving dose in pediatric OHCA?"
Here’s what they found ⬇️
Study Design:
66 paramedics randomized to 3 groups:
• Scenario: School-aged child in asystole
⓵ Standard IV/IO epinephrine
⓶ IM epinephrine with needle/syringe
⓷ IM epinephrine with autoinjector
Key Findings:
⏱️ IM Autoinjector = This was the fastest route.
➡️ Median time to first dose: 1:44
➡️ That’s 1.5 minutes faster than IV/IO (3:27) → p < 0.001
❌ Interestingly when the Epi IM was administered using a needle & syringe there was no time advantage & they found more dosing errors.
💉 The time to vascular access delayed by just 1:07 when using the autoinjector first.
Dosing Accuracy (within 20% of target):
• IV/IO: 95.5%
• IM needle & syringe: 90.9%
• IM autoinjector: 90.9%
Takeaways:
• IM autoinjectors may be a game-changer to beat that 5-minute clock for first-dose Epi
• While not a replacement for IV/IO, it gets Epi on board quickly
• Pre-filled syringes or optimized pediatric-specific autoinjectors might be a next step
Conclusion:�In a controlled simulation, IM epinephrine via autoinjector was significantly faster for that crucial first dose, and could be a valuable tool in real-world pediatric cardiac arrests, especially in rural or resource-limited settings
📚 Read the full study here: https://ow.ly/ugy250XeSK6
