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    A randomized trial of epinephrine in out-of-hospital cardiac arrest

    Access Status
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    Authors
    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.
    Date
    2018
    Type
    Journal Article
    
    Metadata
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    Citation
    Perkins, G. and Ji, C. and Deakin, C. and Quinn, T. and Nolan, J. and Scomparin, C. and Regan, S. et al. 2018. A randomized trial of epinephrine in out-of-hospital cardiac arrest. New England Journal of Medicine. 379 (8): pp. 711-721.
    Source Title
    New England Journal of Medicine
    DOI
    10.1056/NEJMoa1806842
    ISSN
    0028-4793
    School
    School of Nursing, Midwifery and Paramedicine
    URI
    http://hdl.handle.net/20.500.11937/71868
    Collection
    • Curtin Research Publications
    Abstract

    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.

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