Epinephrine Lowers Mortality in Out-of-Hospital Cardiac Arrest — But at What Cost?

In a randomized placebo-controlled trial, mortality was lower in patients treated with epinephrine, but more of those who survived after epinephrine had severe neurological impairment.

Epinephrine has been shown to improve survival in out-of-hospital cardiac arrest (OHCA; NEJM JW Emerg Med Apr 2018 and Circulation 2018; 137:2032), but observational studies have shown that more of these survivors may have worse neurologic outcomes (NEJM JW Emerg Med May 2012 and JAMA 2012; 307:1161; Physician's First Watch Dec 2 2014 and J Am Coll Cardiol 2014; 64:2360). To determine the efficacy and safety of epinephrine for OHCA, researchers in the U.K. conducted a multicenter, randomized, placebo-controlled, double-blind trial (PARAMEDIC2) in adult patients with OHCA who had not regained spontaneous circulation upon emergency medical services (EMS) arrival. Paramedics treated 8014 patients (mean age, 70 years; 65% male) with epinephrine…

Reviewing Author

Ali S. Raja, MD, MBA, MPH

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Board Member); American College of Healthcare Executives – Massachusetts (Board Member)

Ali S. Raja, MD, MBA, MPH

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Board Member); American College of Healthcare Executives – Massachusetts (Board Member)

Epinephrine Lowers Mortality in Out-of-Hospital Cardiac Arrest — But at What Cost?

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Reviewing Author