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
8014 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)
Keywords
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Article info
Publication history
Published online: January 29, 2021
Accepted:
January 18,
2021
Received in revised form:
January 10,
2021
Received:
July 20,
2020
Identification
Copyright
© 2021 Published by Elsevier B.V.
