A randomized trial of epinephrine in out-of-hospital cardiac arrest
Copyright © 2018 Massachusetts Medical Society. 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 placebocontrolled trial to determine whether the use of epinephrine is safe and eff...
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| Format: | Journal Article |
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Massachusetts Medical Society
2018
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| Online Access: | http://hdl.handle.net/20.500.11937/71868 |
| _version_ | 1848762594669625344 |
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| author | Perkins, G. Ji, C. Deakin, C. Quinn, T. Nolan, J. Scomparin, C. Regan, S. Long, J. Slowther, A. Pocock, H. Black, J. Moore, F. Fothergill, R. Rees, N. O'Shea, L. Docherty, M. Gunson, I. Han, K. Charlton, K. Finn, Judith Petrou, S. Stallard, N. Gates, S. Lall, R. |
| author_facet | Perkins, G. Ji, C. Deakin, C. Quinn, T. Nolan, J. Scomparin, C. Regan, S. Long, J. Slowther, A. Pocock, H. Black, J. Moore, F. Fothergill, R. Rees, N. O'Shea, L. Docherty, M. Gunson, I. Han, K. Charlton, K. Finn, Judith Petrou, S. Stallard, N. Gates, S. Lall, R. |
| author_sort | Perkins, G. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Copyright © 2018 Massachusetts Medical Society. 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 placebocontrolled 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. |
| first_indexed | 2025-11-14T10:50:03Z |
| format | Journal Article |
| id | curtin-20.500.11937-71868 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T10:50:03Z |
| publishDate | 2018 |
| publisher | Massachusetts Medical Society |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-718682020-06-15T03:33:33Z A randomized trial of epinephrine in out-of-hospital cardiac arrest Perkins, G. Ji, C. Deakin, C. Quinn, T. Nolan, J. Scomparin, C. Regan, S. Long, J. Slowther, A. Pocock, H. Black, J. Moore, F. Fothergill, R. Rees, N. O'Shea, L. Docherty, M. Gunson, I. Han, K. Charlton, K. Finn, Judith Petrou, S. Stallard, N. Gates, S. Lall, R. Copyright © 2018 Massachusetts Medical Society. 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 placebocontrolled 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. 2018 Journal Article http://hdl.handle.net/20.500.11937/71868 10.1056/NEJMoa1806842 Massachusetts Medical Society restricted |
| spellingShingle | Perkins, G. Ji, C. Deakin, C. Quinn, T. Nolan, J. Scomparin, C. Regan, S. Long, J. Slowther, A. Pocock, H. Black, J. Moore, F. Fothergill, R. Rees, N. O'Shea, L. Docherty, M. Gunson, I. Han, K. Charlton, K. Finn, Judith Petrou, S. Stallard, N. Gates, S. Lall, R. A randomized trial of epinephrine in out-of-hospital cardiac arrest |
| title | A randomized trial of epinephrine in out-of-hospital cardiac arrest |
| title_full | A randomized trial of epinephrine in out-of-hospital cardiac arrest |
| title_fullStr | A randomized trial of epinephrine in out-of-hospital cardiac arrest |
| title_full_unstemmed | A randomized trial of epinephrine in out-of-hospital cardiac arrest |
| title_short | A randomized trial of epinephrine in out-of-hospital cardiac arrest |
| title_sort | randomized trial of epinephrine in out-of-hospital cardiac arrest |
| url | http://hdl.handle.net/20.500.11937/71868 |