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

RESUSCITATION

卷:140

Article

Perkins, Gavin D.^1,2  Kenna, Claire¹  Ji, Chen¹  Deakin, Charles D.^3,4  Nolan, Jerry P.^1,5  Quinn, Tom^6,7  Fothergill, Rachael⁸  Gunson, Imogen⁹  Pocock, Helen³  Rees, Nigel¹⁰  Charlton, Karl¹¹  Finn, Judith¹²  Gates, Simon¹³  Lall, Ranjit¹ 

[1] Univ Warwick, Warwick Clin Trials Unit, Coventry CV4 7AL, W Midlands, England

[2] Univ Hosp Birmingham NHS Fdn Trust, Heartlands Hosp, Birmingham B9 5SS, W Midlands, England

[3] South Cent Ambulance Serv NHS Fdn Trust, Otterbourne SO21 2RU, England

[4] NIHR Southampton Resp Biomed Res Unit, Southampton SO16 6YD, Hants, England

[5] Royal United Hosp, Bath BA1 3NG, Avon, England

[6] Kingston Univ, 6th Floor,Hunter Wing,Cranmer Terrace, London SW17 0RE, England

[7] St Georges Univ London, 6th Floor,Hunter Wing,Cranmer Terrace, London SW17 0RE, England

[8] London Ambulance Serv NHS Trust, 8-20 Pocock St, London SE1 0BW, England

[9] West Midlands Ambulance Serv Univ NHS Fdn Trust, Brierley Hill DY5 1LX, W Midlands, England

[10] Welsh Ambulance Serv NHS Trust, Swansea SA2 8PP, W Glam, Wales

[11] North East Ambulance Serv NHS Fdn Trust, Newcastle Upon Tyne NE15 8NY, Tyne & Wear, England

[12] Curtin Univ, Perth, WA, Australia

[13] Univ Birmingham, Canc Res UK Clin Trials Unit, Birmingham B15 2TT, W Midlands, England

关键词: Adrenaline;    Advanced life support;    Cardiac arrest;    Epinephrine;    Vasopressors;   

DOI  :  10.1016/j.resuscitation.2019.05.007

来源: Elsevier

【 摘 要 】

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 degrees. CI 5.6-7.6)) compared with shockable rhythms 349/716 (48.7%) versus (208/702 (29.6%), adjusted OR: 2.3, 95 degrees.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.

【 授权许可】

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