PARAMEDIC2 – Epinephrine vs Placebo OHCA 6-12 Months

March 25, 2021

Written by Clay Smith

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More patients in PARAMEDIC2 who received epinephrine vs placebo survived for 6 or 12 months, but epinephrine did not improve favorable neurological outcome, mirroring the 30-day results of the original trial.

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Why does this matter?
PARAMEDIC2 was a large RCT comparing epinephrine vs placebo for patients with OHCA that found improved survival to discharge at 30 days but not neurologically intact survival. In fact, those who survived and received epinephrine had more severe neurological impairment. How did patients do longer term?

More survive but not intact
This was a long-term follow up of 8,014 patients from the PARAMEDIC2 trial at 6 and 12 months from enrollment. Of these, “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]).” However, more patients who received epinephrine were alive at 6 months: 117 (2.9%) epinephrine vs 86 (2.2%) placebo, aOR 1.43 (95%CI 1.05-1.96). This dropped to 107 (2.7%) and 80 (2.0%), respectively at 12-months (aOR 1.38, 1.00-1.92). In brief, long term follow up of patients in PARAMEDIC2 was similar to the 30-day results.

This single figure tells the story.

Source
Long term outcomes of participants in the PARAMEDIC2 randomised trial of adrenaline in out-of-hospital cardiac arrest. Resuscitation. 2021 Jan 30;160:84-93. doi: 10.1016/j.resuscitation.2021.01.019. Online ahead of print.