Epinephrine in Out-of-Hospital Cardiac Arrest

Should there be a concern with the use of epinephrine as a treatment for out-of-hospital cardiac arrest? In a study published in the New England Journal of Medicine, researchers aim to assess if the use of epinephrine is safe and effective in this patient population.  

In other to evaluate if epinephrine is safe and effective for out-of-hospital cardiac arrest patients, International Liaison Committee on Resuscitation requested a placebo-controlled trial. The randomized, double-blind trial involved 8,014 patients with out-of-hospital cardiac arrest in the United Kingdom. Throughout the study, paramedics administered either epinephrine (4,015 patients) or saline placebo (3,999 patients). Regular standard of care was provided to both groups. The primary outcome was the rate of survival at 30 days. 

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest (PARAMEDIC2 trial) https://t.co/r9uHhc4GC0 pic.twitter.com/Vrfx7lfMHF

— NEJM (@NEJM) August 19, 2018

At 30 days, the results of the study showed that 130 patients (3.2%) in the epinephrine group and 94 (2.4%) in the placebo group were alive (unadjusted odds ratio for survival, 1.39; 95% confidence interval [CI], 1.06 to 1.82; P=0.02). In addition, there was no evidence of a significant difference in the proportion of patients who survived until hospital discharge with a favorable neurologic outcome (87 of 4,007 patients [2.2%] vs 74 of 3,994 patients [1.9%]; unadjusted odds ratio, 1.18; 95% CI, 0.86 to 1.61). 

Does Epinephrine REALLY work in cardiac arrest? PARAMEDIC2 trial results are in!

Study: 8,014 Patients – randomized to 2 groups: normal epinephrine or saline during cardiac arrest.

Results: At 30 days, 3.2% survived… https://t.co/DKpwpCuu9x

— Brad Raetzke, MD (@FR_medconsult) August 21, 2018

EPI study we've been waiting for! https://t.co/8vdZS2ynjw EPI increases survival in cardiac arrest…slightly…with worse neurologic outcome. Key question: Would YOU use EPI if your family member had cardiac arrest?? #foamed @UMEmergencyMed

— Amal Mattu (@amalmattu) August 13, 2018

“In adults with out-of-hospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of 30-day survival than the use of placebo, but there was no significant between-group difference in the rate of a favorable neurologic outcome because more survivors had severe neurologic impairment in the epinephrine group,” the researchers concluded. 

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest#medic #paramedic #cardiacarrest https://t.co/5JvWKssHdh

— Julie G (@tacbarbie44) August 14, 2018

Check out an article on how trainees view the field of cardiology.  

SOURCE: New England Journal of Medicine