A randomised placebo controlled trial of adrenaline in cardiac arrest—The PACA trial

Abstract

Secondary Endpoints: ROSC and neurological outcome at discharge Results: During the study period paramedics attended 4107 cardiac arrests of which resuscitation was commenced in 1586 (38.6%) patients. Of these 602 (37.9%) were enrolled into the study with a further 67 (11.1%) being excluded after randomization. Of the remaining 535 patients 262 (48.9%) and 273 (51.0%) received placebo or adrenaline respectively. The percentage male (70.6% versus 74.8%); mean age (64.8 versus 65.4 years) and percentage of patients who received bystander CPR (55.7% versus 53.1%) were similar for the adrenaline and placebo groups respectively. ROSC was achieved in 83 (30.4%) patients receiving adrenaline and 29 (11.1%) receiving placebo OR= 3.51 [95% CI 2.21 to 5.58]. Survival to hospital discharge occurred in 11 (4.1%) and 5 (1.9%) of the adrenaline and placebo patients OR= 2.16 [95% CI: 0.74 to 6.30] Primary Outcome: SDC occurred in 11 (4.1%) and 5 (1.9%) of the adrenaline and placebo patients respectively . Conclusion: The use of adrenaline in cardiac arrest was associated with a significant increase in the proportion of patients achieving ROSC however this improvement did not extend to SDC. Implications: The results are unable to rule out a clinically meaningful benefit of Epinephrine in terms of SDC, further investigation into the post resuscitation period for those achieving ROSC is required to identify management strategies to improve survival. A Randomised Placebo Controlled Trial of Adrenaline in Cardiac Arrest The PACA Trial