I'm Anton Hellman.

I'm Justin Morganstern.

And I'm Rory Spiegel.

And this is the Journal Jam podcast.

At this year's Resuscitation and Motion Conference, I recorded a live podcast with four of the world's leading researchers in cardiac arrest for EM cases.

And among other topics, I asked them their opinions on the timing, dose, and specific indications for epinephrine in cardiac arrest.

And no surprise, there wasn't even any consensus on whether or not to give epinephrine in the first place.

There wasn't even any consensus on timing or dose either, except maybe the earlier the better.

There wasn't any consensus on which patients are most likely to benefit from epinephrine even.

Some cited papers showing higher doses in earlier administration of epi, increasing

ROSC rates, while other cited papers showing lower doses improving cerebral profusion pressure.

There was talk about titrating epi to a diastolic blood pressure from an art line,

which some docs have apparently adopted in their practice.

There was also talk about titrating to infrared spectroscopy cerebral oxygenation,

which sounds kind of promising, but has a whole slew of practical problems and no promising

outcome data.

Now, this resuscitation and motion conference was held just before the huge paramedic two

trial, which was published in the New England Journal of Medicine.

And I got to tell you, paramedic 2 has sparked an explosion of activity in the foam world, which, of course, we're going to get to in this podcast.

Now, all this aside, the big question remains, does epinephrine improve the chances of return of spontaneous circulation at the expense of the brain?

In other words, while we know that epinephrine doubles rates of rosk in all comers in cardiac arrest, there's never been robust evidence for long-term improvements in neurological functional outcomes.

So are we saving lives or are we prolonging death? So with this question in mind, Rory, let's hear a quick overview of what we'll

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