6/29/23, 1:34 AM PARAMEDIC2 Pathway Feedback Search Clinical Topics Home Studies PARAMEDIC2 PARAMEDIC2 Disease Cardiac arrest Trial question What is the effect of epinephrine in adult patients with out-of-hospital cardiac arrest? Study design Multi-center Double blinded RCT Population Characteristics of study participants 35.0% female N = 8014 65.0% male 8014 patients (2821 female, 5193 male) Inclusion criteria: patients with out-of-hospital cardiac arrest Key exclusion criteria: known or apparent pregnancy, an age < 16 years, cardiac arrest from anaphylaxis or asthma, or the administration of epinephrine before the arrival of the trial-trained paramedic Interventions N=4015 epinephrine (a single dose of 1 mg of epinephrine administered by an intravenous or intraosseous route every 3 to 5 minutes) N=3999 placebo (a single dose of 0.9% saline administered by an intravenous or intraosseous route every 3 to 5 minutes) https://web.pathway.md/studies/recRdqbhubTxK7qnh 1/2 6/29/23, 1:34 AM PARAMEDIC2 Pathway Primary outcome Rate of survival at 30 days 3.2 % 3.2 2.4 % 2.4 1.6 % Significant increase 0.8 % NNT = 125 0.0 % Epinephrine Placebo Significant increase in rate of survival at 30 days (3.2% vs. 2.4%; OR 1.39, 95% CI 1.06 to 1.82) Secondary outcomes No significant difference in rate of survival until hospital discharge with a favorable neurologic outcome, as indicated by a score 3 on the mRS (2.2% vs. 1.9%; OR 1.18, 95% CI 0.86 to 1.61) Borderline significant increase in survival until hospital admission (23.8% vs. 8%; OR 3.59, 95% CI 3.14 to 4.12) Borderline significant increase in survival at 3 months (3% vs. 2.2%; OR 1.41, 95% CI 1.07 to 1.87) Safety outcomes No significant difference in favorable neurologic outcome at 3 months. Significant difference in severe neurologic impairment at hospital discharge (31.0% vs. 17.8%). Conclusion In patients with out-of-hospital cardiac arrest, epinephrine was superior to placebo with respect to the rate of survival at 30 days. Reference Gavin D Perkins, Chen Ji, Charles D Deakin et al. A Randomized Trial of Epinephrine in Out-of- Hospital Cardiac Arrest. N Engl J Med. 2018 Aug 23;379(8):711-721. Open reference URL https://web.pathway.md/studies/recRdqbhubTxK7qnh 2/2