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The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms : findings from the PACA and PARAMEDIC-2 randomised controlled trials
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Perkins, Gavin D., Kenna, Claire, Ji, Chen, Deakin, Charles, Nolan, Jerry P., Quinn, Tom, Fothergill, Rachel T., Gunson, Imogen, Pocock, Helen, Rees, Nigel, Charlton, Karl, Finn, Judith, Gates, Simon and Lall, Ranjit (2019) The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms : findings from the PACA and PARAMEDIC-2 randomised controlled trials. Resuscitation, 140 . pp. 55-63. doi:10.1016/j.resuscitation.2019.05.007 ISSN 0300-9572.
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Official URL: http://doi.org/10.1016/j.resuscitation.2019.05.007
Abstract
Introduction
Previous research suggests there may be differences in the effects of adrenaline related to the initial cardiac arrest rhythm. The aim of this study was to assess the effect of adrenaline compared with placebo according to whether the initial cardiac arrest rhythm was shockable or non-shockable.
Methods
Return of spontaneous circulation (ROSC), survival and neurological outcomes according to the initial arrest rhythm were compared amongst patients enrolled in the PARAMEDIC-2 randomised, placebo controlled trial. The results of the PARAMEDIC-2 and PACA out of hospital cardiac arrest trials were combined and meta-analysed.
Results
The initial rhythm was known for 3,929 (98.2%) in the placebo arm and 3,919 (97.6%) in the adrenaline arm. The effect on the rate of ROSC of adrenaline relative to placebo was greater in patients with non-shockable cardiac rhythms (1002/3003 (33.4%) versus 222/3005 (7.4%), adjusted OR: 6.5, (95% CI 5.6-7.6)) compared with shockable rhythms 349/716 (48.7%) versus (208/702 (29.6%), adjusted OR: 2.3, 95%CI: 1.9-2.9)). The adjusted odds ratio for survival at discharge for non-shockable rhythms was 2.5 (1.3, 4.8) and 1.3 (0.9, 1.8) for shockable rhythms (P value for interaction 0.065) and 1.8(0.8-4.1) and 1.1 (0.8-1.6) respectively for neurological outcome at discharge (P value for interaction 0.295). Meta-analysis found similar results.
Conclusion
Relative to placebo, the effects of adrenaline ROSC are greater for patients with an initially non-shockable rhythm than those with a shockable rhythms. Similar patterns are observed for longer term survival outcomes and favourable neurological outcomes, although the differences in effects are less pronounced.
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 | ||||||||
Journal or Publication Title: | Resuscitation | ||||||||
Publisher: | Elsevier Ireland Ltd | ||||||||
ISSN: | 0300-9572 | ||||||||
Official Date: | 1 July 2019 | ||||||||
Dates: |
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Volume: | 140 | ||||||||
Page Range: | pp. 55-63 | ||||||||
DOI: | 10.1016/j.resuscitation.2019.05.007 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
Date of first compliant deposit: | 22 May 2019 | ||||||||
Date of first compliant Open Access: | 19 May 2020 | ||||||||
RIOXX Funder/Project Grant: |
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