Adrenaline in Cardiac Arrest; PARAMEDIC2

The Resus Room

Simon Laing

Science, Emergencymedicine, Medicine, Health & Fitness, Em, Ae

4.8 • 678 Ratings

🗓️ 25 July 2018

⏱️ 37 minutes

🔗️ Recording | iTunes | RSS

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Summary

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?

Transcript

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0:00.0	Welcome to the Recess Room podcast.
0:03.9	Five, four, three, two, one, fire.
0:13.1	So hi, and welcome back to the Recess Room podcast. I'm Simon Lang. I'm Rob Fenwick. And I'm James Yates.
0:20.5	And this is, it's fair to say, a bit of a special episode.
0:25.2	It is, it's like an extraordinary general meeting, isn't it?
0:28.7	Something wonderful has occurred.
0:32.2	That's right, yeah.
0:33.1	We promised each other we're definitely having a break for the summer.
0:36.5	About three days later, the text comes in.
0:39.1	We've got to talk about this.
0:40.9	Excellent. Yeah, three-day holiday. It's beautiful.
0:43.7	But the beauty of this is that we haven't had to do any of the hard work.
0:46.5	So you will no doubt have heard in the press very recently,
0:51.3	there's been the paramedic two trial, looks at adrenaline in out of hospital cardiac arrest.
0:58.5	We're not going to do a huge introduction to the topic because the primary author in this scoop has been kind enough to come on and run through the paper and a lot of the questions that have been out there online about this.
1:10.6	So as you say, it's a really special episode and we are hugely grateful to Professor
1:14.7	Gavin Perkins for giving us this opportunity.
1:17.7	And of course, for not reporting you to the police for harassing him to get that interview.
1:25.2	It worked, though.
1:26.1	Well done, Simon.
1:27.6	That drone into his bedroom window works.
1:29.7	Absolutely.
	...

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