Long term outcomes of participants in the PARAMEDIC2 randomised trial of adrenaline in out-of-hospital cardiac arrest

Research output: Contribution to journalArticlepeer-review

Authors

  • Kirstie L Haywood
  • Chen Ji
  • Tom Quinn
  • Jerry P Nolan
  • Charles D Deakin
  • Charlotte Scomparin
  • Ranjit Lall
  • John Long
  • Scott Regan
  • Rachael T Fothergill
  • Helen Pocock
  • Nigel Rees
  • Lyndsey O'Shea
  • Gavin D Perkins

Colleges, School and Institutes

External organisations

  • University of Warwick
  • Kingston University and St George's, University of London
  • South Central Ambulance Service NHS Foundation Trust
  • Swansea University

Abstract

AIMS: We recently reported early outcomes in patients enrolled in a randomised trial of adrenaline in out-of-hospital cardiac arrest: the PARAMEDIC2 (Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest) trial. The purpose of the present paper is to report long-term survival, quality of life, functional and cognitive outcomes at 3, 6 and 12-months.

METHODS: PARAMEDIC2 was a pragmatic, individually randomised, double blind, controlled trial with an economic evaluation. Patients were randomised to either adrenaline or placebo. This paper reports results on the modified Rankin Scale scores at 6-months, survival at 6 and 12-months, as well as other cognitive, functional and quality of life outcomes collected at 3 and 6 months (Two Simple Questions, the Mini Mental State Examination, the Informant Questionnaire on Cognitive Decline Evaluation for Cardiac Arrest, Hospital Anxiety and Depression Scale, the Post Traumatic Stress Disorder Checklist - Civilian Version, Short-Form 12-item Health Survey and the EuroQoL EQ-5D-5L).

RESULTS: 8,014 patients were randomised with confirmed trial drug administration. At 6-months, 78 (2.0%) of the patients in the adrenaline group and 58 (1.5%) of patients in the placebo group had a favourable neurological outcome (adjusted odds ratio 1.35 [95% confidence interval: 0.93, 1.97]). 117 (2.9%) patients were alive at 6-months in the adrenaline group compared with 86 (2.2%) in the placebo group (1.43 [1.05, 1.96], reducing to 107 (2.7%) and 80 (2.0%) respectively at 12-months (1.38 [1.00, 1.92]). Measures of 3 and 6-month cognitive, functional and quality of life outcomes were reduced, but there was no strong evidence of differences between groups.

CONCLUSION: Adrenaline improved survival through to 12-months follow-up. The study did not find evidence of improvements in favourable neurological outcomes. (ISCRTN 73485024).

Bibliographic note

Funding Information: Dr. Quinn reports grants from National Institute for Health Research, during the conduct of the study; grants from British Heart Foundation, grants from the Gas Safety Trust, outside the submitted work. The trial was funded by the NIHR Health Technology Assessment Programme , grant number 12/127/126 and supported by NIHR Applied Research Collaboration West Midlands and Health and Care Research Wales. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Dr. Perkins reports grants from National Institute for Health Research, during the conduct of the study; grants from British Heart Foundation, grants from Resuscitation Council UK, non-financial support from European Resuscitation Council, non-financial support from International Liaison Committee on Resuscitation, outside the submitted work. Publisher Copyright: © 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

Details

Original languageEnglish
Pages (from-to)84-93
Number of pages10
JournalResuscitation
Volume160
Early online date30 Jan 2021
Publication statusPublished - Mar 2021

Keywords

  • Adrenaline, Cardiac arrest, Cognitive, Drugs, Functional, Health related quality of life, Long term