ESPEYB16 8. Adrenals Clinical Trials - New Treatments (2 abstracts)
8.9. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest
Perkins GD , Ji C , Deakin CD , Quinn T , Nolan JP , Scomparin C , Regan S , Long J , Slowther A , Pocock H , Black JJM , Moore F , Fothergill RT , Rees N , O’Shea L , Docherty M , Gunson I , Han K , Charlton K , Finn J , Petrou S , Stallard N , Gates S , Lall R & PARAMEDIC2 Collaborators
Warwick Clinical Trials Unit and Warwick Medical School, University of Warwick, Coventry, UK
To read the full abstract: N Engl J Med. 2018; 379(8): 711–721.
In attempting to reduce the rate of death and disability associated with cardiac arrest worldwide, emergency medical workers have few effective treatments other than early initiation of cardiopulmonary resuscitation (CPR) and prompt defibrillation. Epinephrine (adrenaline) has potentially beneficial effects in cardiac arrest through the constriction of arterioles mediated by α-adrenergic receptors. Potentially harmful effects on the heart are mediated through β-adrenergic stimulation, which causes dysrhythmias and increased myocardial oxygen demand and increases the risk of recurrent cardiac arrest. In addition, α-adrenergic stimulation causes platelet activation, which promotes thrombosis and impairs the microvascular blood flow in the cerebral cortex, which in turn increases the severity of cerebral ischemia during CPR and after a return of spontaneous circulation.
The International Liaison Committee on Resuscitation, a consortium of 7 major organizations involved in the field of resuscitation, initiated the PARAMEDIC2 (Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest) trial in 8016 UK patients to determine whether epinephrine (1.0 mg every 3–5 minutes) is beneficial or harmful as a treatment for out-of-hospital cardiac arrest. In this trial, epinephrine during resuscitation for out-of-hospital cardiac arrest significantly improved survival at 30 days compared to placebo. Patients in the epinephrine group had a higher rate of return of spontaneous circulation, a higher frequency of transport to hospital, and a higher rate of treatment in the ICU. However, more patients in the epinephrine group survived with severe neurologic disability, and there was no effect of epinephrine on the rate of survival with a favorable neurologic outcome.
These findings show that the use of epinephrine for out-of-hospital cardiac arrest improves survival, however, at the risk of increased severe neurological disability, thereby making the decision of using it in the context of out-of-hospital cardiac arrest a very difficult one.
Volume 16
Article tools
My recent searches
My recently viewed abstracts
Authors
ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more