The intracardiac administration of medications in cardiac arrest is advocated when an intravenous route cannot be established. Although warnings of complications of this mode of therapy are reiterated throughout the literature, their careful documentation is lacking. Paramedics were trained to administer intracardiac medications, under strict criteria, in patients with prehospital sudden cardiac death. Long-term survivors who received intracardiac medications from paramedics were compared to a control group resuscitated by paramedics with intravenous medications alone. By far, the patients who received intracardiac medications were more nearly refractory to resuscitation because of the criteria for intracardiac medication use. Potential complications of the intracardiac route were identified and sought. However, complications were no more common in this group of patients than in the control group. Paramedics can successfully administer intracardiac medications when indicated.