PARAMEDIC-2
Trial question
What is the effect of epinephrine in adult patients with out-of-hospital cardiac arrest?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
35.0% female
65.0% male
N = 8014
8014 patients (2821 female, 5193 male).
Inclusion criteria: patients with out-of-hospital cardiac arrest.
Key exclusion criteria: known or apparent pregnancy, an age < 16 years, cardiac arrest from anaphylaxis or asthma, or the administration of epinephrine before the arrival of the trial-trained paramedic.
Interventions
N=4015 epinephrine (a single dose of 1 mg of epinephrine administered by an intravenous or intraosseous route every 3 to 5 minutes).
N=3999 placebo (a single dose of 0.9% saline administered by an intravenous or intraosseous route every 3 to 5 minutes).
Primary outcome
Rate of survival at 30 days
3.2%
2.4%
3.2 %
2.4 %
1.6 %
0.8 %
0.0 %
Epinephrine
Placebo
Significant
increase ▲
NNT = 124
Significant increase in rate of survival at 30 days (3.2% vs. 2.4%; OR 1.39, 95% CI 1.06 to 1.82).
Secondary outcomes
No significant difference in rate of survival until hospital discharge with a favorable neurologic outcome, as indicated by a score ≤ 3 on the mRS (2.2% vs. 1.9%; OR 1.18, 95% CI 0.86 to 1.61).
Significant increase in survival until hospital admission (23.8% vs. 8%; OR 3.59, 95% CI 3.14 to 4.12).
Significant increase in survival at 3 months (3% vs. 2.2%; OR 1.41, 95% CI 1.07 to 1.87).
Safety outcomes
No significant difference in favorable neurologic outcome at 3 months.
Significant difference in severe neurologic impairment at hospital discharge (31.0% vs. 17.8%).
Conclusion
In patients with out-of-hospital cardiac arrest, epinephrine was superior to placebo with respect to the rate of survival at 30 days.
Reference
Gavin D Perkins, Chen Ji, Charles D Deakin et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2018 Aug 23;379(8):711-721.
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