Drugs in cardiac arrest are controversial. Prehospital research is notoriously difficult to perform. PARAMEDIC2 has just published in the New England Journal of Medicine and is a multi centre randomised placebo controlled trial looking at adrenaline (or epinephrine depending on which side of the pond you reside) in out of hospital cardiac arrest, no mean undertaking and a landmark paper.
The paper has gained a huge amount of traction online with multiple blogs discussing the primary outcome which showed a higher survival rate in those receiving adrenaline when compared to placebo. This has been accompanied with a firm debate over the secondary outcomes, which include the rate of survival with a favourable neurological outcome (mRS 0-3), which showed no statistically significant difference between the two treatment arms, but in pure numbers gave a higher proportion of favourable outcomes in the adrenaline group.
The trade off for this increased survival is the significant number of survivors with a poor neurological outcome.
The question on everyone's lips then being; should we continue to administer adrenaline in cardiac arrest given the findings from this study?
In the podcast we run over the main findings of the paper and are lucky enough to speak to the lead author Professor Gavin Perkins about the paper and some of the questions we and you have had following publication of the paper. A huge thanks to Gavin for taking the time to do this.
Have a listen, enjoy, and let us know any thoughts or feedback you have
Simon, Rob & James
References & Further Reading
PARAMEDIC2; Warwick University Clinical Trials Unit
A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. Perkins GD. N Engl J Med. 2018
PARAMEDIC2 Protocol
Testing Epinephrine for Out-of-Hospital Cardiac Arrest. Callaway CW. N Engl J Med. 2018
First10EMParamedic 2: Epinephrine harms/helps in out of hospital cardiac arrest
REBEL Cast Ep56 PARAMEDIC-2: Time to Abandon Epinephrine in OHCA?