To the Editor: Dr Hagihara and colleagues1 analyzed the use of prehospital epinephrine in patients with out-of-hospital cardiac arrest. We have several concerns about the study.
The cohort of patients receiving epinephrine comprised a fraction of the overall population (15 030 of 417 188; 4%) for reasons not addressed by the authors and that could represent selection bias. Given that epinephrine was part of the treatment algorithm, insight into reasons for this would allow for better interpretation of the data.
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