Results of a National Institute for Health Research funded clinical trial investigated the use of adrenaline during resuscitation for out-of-hospital cardiac arrest. Adrenaline use resulted in only 1% more people leaving the hospital alive but the risk for severe brain damage for cardiac arrest survivors almost doubled. Findings were published in the journal The New England Journal of Medicine.
PARAMEDIC2 was a double-blind trial involving 8014 patients with out-of-hospital cardiac arrest in the United Kingdom. Patients were administered either parenteral epinephrine (n=4015) or saline placebo (n=3999), along with standard care. Rate of survival at 30 days was the primary outcome.
At 30 days, 3.2% vs 2.4% patients were alive in epinephrine vs placebo group (OR, 1.39; P=.02). To prevent 1 death at 30 days, number of patients who would need to be treated with epinephrine was 112 (95% CI, 63-500). However, number of patients discharged from the hospital with favourable neurologic outcome was not different between 2 groups (2.2% vs 1.9%; OR, 1.18; 95% CI, 0.86-1.61). 31.0% vs 17.8% patients in epinephrine vs placebo group had severe neurologic impairment.
Lead author, Professor Gavin Perkins from the University of Warwick commented: “The benefits of adrenaline were small, 1 extra survivor for every 125 patients treated, but the use of adrenaline almost doubled the risk for a severe brain damage amongst survivors.” He further added, “These findings will require careful consideration by the wider community and those responsible for clinical practice guidelines for cardiac arrest.”
