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A randomized trial of epinephrine in out-of-hospital cardiac arrest
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PARAMEDIC2 Collaborators (Including:
). (2018) A randomized trial of epinephrine in out-of-hospital cardiac arrest. New England Journal Of Medicine , 379 . pp. 711-721. doi:10.1056/NEJMoa1806842 ISSN 0028-4793.
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Official URL: http://dx.doi.org/10.1056/NEJMoa1806842
Abstract
Background
Concern about the use of epinephrine as a treatment for out-of-hospital cardiac arrest led the International Liaison Committee on Resuscitation to call for a placebo-controlled trial to determine whether the use of epinephrine is safe and effective in such patients.
Methods
In a randomized, double-blind trial involving 8014 patients with out-of-hospital cardiac arrest in the United Kingdom, paramedics at five National Health Service ambulance services administered either parenteral epinephrine (4015 patients) or saline placebo (3999 patients), along with standard care. The primary outcome was the rate of survival at 30 days. Secondary outcomes included the rate of survival until hospital discharge with a favorable neurologic outcome, as indicated by a score of 3 or less on the modified Rankin scale (which ranges from 0 [no symptoms] to 6 [death]).
Results
At 30 days, 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). 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 4007 patients [2.2%] vs. 74 of 3994 patients [1.9%]; unadjusted odds ratio, 1.18; 95% CI, 0.86 to 1.61). At the time of hospital discharge, severe neurologic impairment (a score of 4 or 5 on the modified Rankin scale) had occurred in more of the survivors in the epinephrine group than in the placebo group (39 of 126 patients [31.0%] vs. 16 of 90 patients [17.8%]).
Conclusions
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. (Funded by the U.K. National Institute for Health Research and others; Current Controlled Trials number, ISRCTN73485024.)
Item Type: | Journal Article | ||||||
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Subjects: | Q Science > QP Physiology R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Cardiac arrest -- Treatment, Adrenaline, Cardiac resuscitation, CPR (First aid) | ||||||
Journal or Publication Title: | New England Journal Of Medicine | ||||||
Publisher: | Massachusetts Medical Society | ||||||
ISSN: | 0028-4793 | ||||||
Official Date: | 23 August 2018 | ||||||
Dates: |
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Volume: | 379 | ||||||
Page Range: | pp. 711-721 | ||||||
DOI: | 10.1056/NEJMoa1806842 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Reuse Statement (publisher, data, author rights): | From New England Journal Of Medicine, PARAMEDIC2 Collaborators (Including: Perkins, Gavin D., Ji, Chen, Deakin, Charles D., Quinn, Tom, Nolan, Jerry P., Scomparin, Charlotte, Regan, Scott, Long, John, Slowther, Anne, Pocock, Helen, Black, John J.M., Moore, Fionna, Fothergill, Rachael T., Rees, Nigel, O’Shea, Lyndsey, Docherty, Mark, Gunson, Imogen, Han, Kyee, Charlton, Karl, Finn, Judith, Petrou, Stavros, Stallard, Nigel, Gates, Simon and Lall, Ranjit)., A randomized trial of epinephrine in out-of-hospital cardiac arrest, 379 . pp. 711-721. doi:10.1056/NEJMoa1806842. Copyright © 2018 Massachusetts Medical Society. Reprinted with permission. | ||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||
Date of first compliant deposit: | 23 July 2018 | ||||||
Date of first compliant Open Access: | 23 February 2019 | ||||||
RIOXX Funder/Project Grant: |
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