The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms: findings from the PACA and PARAMEDIC-2 randomised controlled trials

Research output: Contribution to journalArticlepeer-review

Authors

  • Gavin D Perkins
  • Claire Kenna
  • Chen Ji
  • Charles Deakin
  • Jerry P Nolan
  • Tom Quinn
  • Rachel Fothergill
  • Imogen Gunson
  • Helen Pocock
  • Nigel Rees
  • Karl Charlton
  • Judith Finn
  • Ranjit Lall

Colleges, School and Institutes

External organisations

  • Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK; Heartlands Hospital, University Hospitals Birmingham, Birmingham, B9 5SS, UK. Electronic address: paramedic@warwick.ac.uk.
  • Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK.
  • South Central Ambulance Service NHS Foundation Trust, Otterbourne, SO21 2RU, UK; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, SO16 6YD, UK.
  • Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK; Royal United Hospital, Bath, BA1 3NG, UK.
  • Kingston University and St. George's, University of London, 6th Floor, Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK.
  • London Ambulance Service NHS Trust, 8-20 Pocock Street, London, SE1 0BW, UK.
  • West Midlands Ambulance Service University NHS Foundation Trust, Brierley Hill, West Midlands, DY5 1LX, UK.
  • South Central Ambulance Service NHS Foundation Trust, Otterbourne, SO21 2RU, UK.
  • Welsh Ambulance Services NHS Trust, Swansea, Wales, SA2 8PP, UK.
  • North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, NE15 8NY, UK.
  • School of Psychology & Speech Pathology, Curtin University, Perth, Western Australia

Abstract

INTRODUCTION: Previous research suggests there may be differences in the effects of adrenaline related to the initial cardiac arrest rhythm. The aim of this study was to assess the effect of adrenaline compared with placebo according to whether the initial cardiac arrest rhythm was shockable or non-shockable.

METHODS: Return of spontaneous circulation (ROSC), survival and neurological outcomes according to the initial arrest rhythm were compared amongst patients enrolled in the PARAMEDIC-2 randomised, placebo controlled trial. The results of the PARAMEDIC-2 and PACA out of hospital cardiac arrest trials were combined and meta-analysed.

RESULTS: The initial rhythm was known for 3929 (98.2%) in the placebo arm and 3919 (97.6%) in the adrenaline arm. The effect on the rate of ROSC of adrenaline relative to placebo was greater in patients with non-shockable cardiac rhythms (1002/3003 (33.4%) versus 222/3005 (7.4%), adjusted OR: 6.5, (95% CI 5.6-7.6)) compared with shockable rhythms 349/716 (48.7%) versus (208/702 (29.6%), adjusted OR: 2.3, 95%CI: 1.9-2.9)). The adjusted odds ratio for survival at discharge for non-shockable rhythms was 2.5 (1.3, 4.8) and 1.3 (0.9, 1.8) for shockable rhythms (P value for interaction 0.065) and 1.8 (0.8-4.1) and 1.1 (0.8-1.6) respectively for neurological outcome at discharge (P value for interaction 0.295). Meta-analysis found similar results.

CONCLUSION: Relative to placebo, the effects of adrenaline ROSC are greater for patients with an initially non-shockable rhythm than those with a shockable rhythms. Similar patterns are observed for longer term survival outcomes and favourable neurological outcomes, although the differences in effects are less pronounced. ISRCTN73485024.

Bibliographic note

Copyright © 2019. Published by Elsevier B.V.

Details

Original languageEnglish
Pages (from-to)55-63
Number of pages9
JournalResuscitation
Volume140
Early online date19 May 2019
Publication statusPublished - 1 Jul 2019

Keywords

  • Adrenaline, Advanced life support, Cardiac arrest, Epinephrine, Vasopressors