Cited by 797Cardiac Arrest and ResuscitationPalliative Care and End-of-Life IssuesCardiac electrophysiology and arrhythmias

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A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest

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Perkins, Gavin D., Ji, Chen, Deakin, Charles D., Quinn, Tom, Nolan, Jerry P., Scomparin, Charlotte, Regan, Scott, Long, John, Slowther, Anne, Pocock, Helen, Black, John J.M., Moore, Fionna, Fothergill, Rachael T., Rees, Nigel, O’Shea, Lyndsey, Docherty, Mark, Gunson, Imogen, Han, Kyee, Charlton, Karl, Finn, Judith, Petrou, Stavros, Stallard, Nigel, Gates, Simon, Lall, Ranjit·2018·New England Journal of Medicine

DOI 10.1056/nejmoa1806842

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Abstract

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 placebo-controlled 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. (Funded by the U.K. National Institute for Health Research and others; Current Controlled Trials number, ISRCTN73485024 .).

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Authors: Perkins, G. D., Ji, C., Deakin, C. D., Quinn, T., Nolan, J. P., Scomparin, C., Regan, S., Long, J., Slowther, A., Pocock, H., Black, J. J. M., Moore, F., Fothergill, R. T., Rees, N., O’Shea, L., Docherty, M., Gunson, I., Han, K., Charlton, K., Finn, J., Petrou, S., Stallard, N., Gates, S., & Lall, R.
Affiliations: University of Warwick (GB)
National Institute for Health and Care Research (GB)
St George's, University of London (GB)
Royal United Hospital (GB)
North East Ambulance Service NHS Foundation Trust (GB)
Curtin University (AU)
ORCID: Perkins, Gavin D.
Ji, Chen
Deakin, Charles D.
Quinn, Tom
Nolan, Jerry P.
Scomparin, Charlotte
Regan, Scott
Long, John
Slowther, Anne
Pocock, Helen
Black, John J.M.
Moore, Fionna
Fothergill, Rachael T.
Rees, Nigel
O’Shea, Lyndsey
Docherty, Mark
Gunson, Imogen
Han, Kyee
Charlton, Karl
Finn, Judith
Petrou, Stavros
Stallard, Nigel
Gates, Simon
Lall, Ranjit
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2018-08-23
Volume: 379
Issue: 8
Pages: 711-721
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1806842
OpenAlex: W2883159984
Cited by: 794
References: 35
Citations by year: 2026: 59 · 2025: 88 · 2024: 101 · 2023: 87 · 2022: 74 · 2021: 105 · 2020: 150 · 2019: 102 · 2018: 27
FWCI: 117.30
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.nejmgroup.org/legal/terms-of-use.htm (vor)
Locations: New England Journal of Medicine (publishedVersion)
Monash University Research Portal (Monash University) (publishedVersion, other-oa)
PubMed (publishedVersion)
Research Repository (Kingston University London) (acceptedVersion)
Warwick Research Archive Portal (University of Warwick) (acceptedVersion, other-oa)
eSpace (Curtin University) (submittedVersion)
amber - ambulance research repository (submittedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Explore Bristol Research (submittedVersion)
Funders: Health Technology Assessment Programme (12/127/126)
Topics: Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords: out-of-hospital cardiac arrest, epinephrine, cardiopulmonary resuscitation, 30-day survival, neurological outcome, modified Rankin Scale, paramedics, ambulance services, United Kingdom National Health Service, resuscitation guidelines
MeSH terms: Aged, Combined Modality Therapy, Double-Blind Method, Electric Countershock, Emergency Medical Services, Epinephrine, Female, United Kingdom, Humans, Male, Middle Aged, Nervous System Diseases, Sympathomimetics, Survival Rate, Cardiopulmonary Resuscitation, Hospital Mortality, Out-of-Hospital Cardiac Arrest, Time-to-Treatment

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A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest

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