In our study, pre-hospital epinephrine administration was associated with improved ROSC but with poor neurological outcomes. Although the reason is not clear, this result is also similar to those from previous studies that included OHCA from causes other than respiratory disease. The pre- hospital administration of epinephrine might only salvage patients who otherwise would have died. The association between the presence of a physician in the ambulance and the outcomes in our study may also be due to similar reasons.