Perkins GD, et al. - Experts conducted a placebo-controlled trial to ascertain if the use of epinephrine is safe and effective in patients with out-of-hospital cardiac arrest. The use of epinephrine in adults with out-of-hospital cardiac arrest lead to a significantly higher rate of 30-day survival vs use of placebo. Rate of a favorable neurologic outcome saw no significant between-group difference because more survivors had severe neurologic impairment in the epinephrine group.

Methods

• This is a randomized, double-blind trial involving 8,014 patients with out-of-hospital cardiac arrest in the UK.
• Either parenteral epinephrine (4,015 patients) or saline placebo (3,999 patients), along with standard care was administered by paramedics with five National Health Service ambulance services.
• The rate of survival at 30 days was included in the primary outcome.
• 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) were the secondary outcomes.

Results

• Findings suggested that 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).
• Results did not demonstrate any evidence of a significant difference in the proportion of patients who survived until hospital discharge with a favorable neurologic outcome (87 of 4,007 patients [2.2%] vs 74 of 3,994 patients [1.9%]; unadjusted odds ratio, 1.18; 95% CI, 0.86 to 1.61).
• At the time of hospital discharge, in more of the survivors in the epinephrine group, severe neurologic impairment (a score of 4 or 5 on the modified Rankin scale) had occurred than in the placebo group (39 of 126 patients [31.0%] vs 16 of 90 patients [17.8%]).