Perkins, Gavin D., Kenna, Claire, Ji, Chen, Deakin, Charles D., Nolan, Jerry P., Quinn, Tom, Scomparin, Charlotte, Fothergill, Rachael, Gunson, Imogen, Pocock, Helen, Rees, Nigel, O’Shea, Lyndsey, Finn, Judith, Gates, Simon and Lall, Ranjit (2020) The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial. Intensive Care Medicine, 46 . pp. 426-436. doi:10.1007/s00134-019-05836-2 ISSN 0342-4642.

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Abstract

Purpose
To examine the time to drug administration in patients with a witnessed cardiac arrest enrolled in the Pre-Hospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest (PARAMEDIC2) randomised controlled trial.
Methods
The PARAMEDIC2 trial was undertaken across 5 NHS ambulance services in England and Wales with randomisation between December 2014 and October 2017. Patients with an out-of-hospital cardiac arrest who were unresponsive to initial resuscitation attempts were randomly assigned to 1 mg intravenous adrenaline or matching placebo according to treatment packs that were identical apart from treatment number. Participants and study staff were masked to treatment allocation.
Results
8016 patients were enrolled, 4902 sustained a witnessed cardiac arrest of whom 2437 received placebo and 2465 received adrenaline. The odds of return of spontaneous circulation decreased in both groups over time but at a greater rate in the placebo arm odds ratio (OR) 0.93 (95% CI 0.92–0.95) compared with the adrenaline arm OR 0.96 (95% CI 0.95–0.97); interaction OR: 1.03, 95% CI 1.01–1.05, p = 0.005. By contrast, although the rate of survival and favourable neurological outcome decreased as time to treatment increased, the rates did not differ between the adrenaline and placebo groups.
Conclusion
The rate of return of spontaneous circulation, survival and favourable neurological outcomes decrease over time. As time to drug treatment increases, adrenaline increases the chances of return of spontaneous circulation. Longer term outcomes were not affected by the time to adrenaline administration. (ISRCTN73485024).

Item Type:	Journal Article
Subjects:	Q Science > QP Physiology R Medicine > R Medicine (General) R Medicine > RC Internal medicine R Medicine > RS Pharmacy and materia medica
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
Library of Congress Subject Headings (LCSH):	Drugs—Dosage forms , Drugs -- Effectiveness , Adrenaline -- Therapeutic use -- Effectiveness, Cardiac arrest , Cardiac arrest -- Treatment, Clinical trials
Journal or Publication Title:	Intensive Care Medicine
Publisher:	Springer
ISSN:	0342-4642
Official Date:	March 2020
Dates:	Date Event March 2020 Published 7 January 2020 Available 18 October 2019 Accepted
Volume:	46
Page Range:	pp. 426-436
DOI:	10.1007/s00134-019-05836-2
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	14 January 2020
Date of first compliant Open Access:	14 January 2020
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID 12/127/126 [NIHR] National Institute for Health Research http://dx.doi.org/10.13039/501100000272

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