Epinephrine use in out-of-hospital (OOH) cardiac arrest patient was linked with better 30-day survival, according to a new study in The New England Journal of Medicine. The study authors included 8,014 participants, 4,015 of whom were given parenteral epinephrine by emergency responders, and 3,999 who were given a saline placebo with standard care. Outcomes of interest included survival after 30 days, survival until discharge from the hospital with favorable neurological standing, and severity of neurological deficit.
According to the study results, 130 (3.2%) of patients in the epinephrine group survived 30 days post-incident, compared to 94 (2.4%) of the placebo group (95% CI, 1.06-1.82; P=0.02). Additionally, 87 of 4,007 (2.2%) of patients in the epinephrine group were discharged from the hospital with a favorable neurological outcome compared to 74 of 3,994 (1.9%) in the placebo group. Patients who suffered a severe neurological impairment, however, rated as a score of 4 or 5 on the Rankin Scale, and were more prevalent in the epinephrine group (39 of 126; 31%) compared to the placebo group (16 of 90; 17.8%).
In their conclusion, the researchers added that “there was no significant between-group difference in the rate of a favorable neurological outcome because more survivors had severe neurologic impairment in the epinephrine group.”
#Paramedic2 podcast, interview with the lead author Gavin Perkins
— TheResusRoom (@TheResusRoom) July 20, 2018