Epinephrine Dose: Optimal Versus Standard Evaluation Trial

This study is designed as a prospective, multicentre, single-blinded randomized controlled trial (RCT) where eligible OHCA patients are randomized to receive a low cumulative dose of epinephrine (low dose epinephrine, up to 2mg total) or a standard cumulative dose of epinephrine (standard dose epinephrine, up to 6mg total) in a 1:1 fashion.

Eligible OHCA patients will be treated by paramedics who will initiate cardiopulmonary resuscitation (CPR) and the delivery of defibrillation shocks per paramedic agencies' treatment protocols. After one defibrillation and when feasible, paramedics will establish peripheral intravenous (IV) access, and patients will be randomly allocated to either the low dose or standard dose treatment arm. Epinephrine doses (according to treatment assignment) will be administered every 3-5 minutes, based on current guidelines and paramedic protocols, until the first return of spontaneous circulation (ROSC) is achieved or if resuscitation has been terminated by the base hospital physician. Other medications (e.g. antiarrhythmics, magnesium, beta blockers) and interventions (e.g. intubation) may be interposed as required. Follow-up will take place using a combination of administrative databases (e.g. the Discharge Abstract Database and the National Ambulatory Care Reporting System) and telephone interviews.

This RCT will evaluate a fundamental change in the treatment of OHCA. The investigators hypothesize that a low cumulative dose of epinephrine will improve patient survival to hospital discharge compared to a standard cumulative dose of epinephrine. Please feel free to contact epidose@unityhealth.to for further information.

• Return of spontaneous circulation in out-of-hospital setting [Срок оценки: Through study completion (up to 5 years)]
• Survival to emergency department arrival [Срок оценки: Through study completion (up to 5 years)]
• Survival to admission with death prior to discharge [Срок оценки: Through study completion (up to 5 years)]
• Survival to discharge outside of a long-term healthcare facility e.g. nursing home [Срок оценки: Through study completion (up to 5 years)]
• Modified Rankin Scale (mRS) score [Срок оценки: 12+/-3 months]
• Health Utility Index-3 (HUI-3) score [Срок оценки: 12+/-3 months]
• Hospital Anxiety and Depression Scale score [Срок оценки: 12+/-3 months]
• Length of stay in hospital [Срок оценки: Through study completion (up to 5 years)]
• Length of stay in critical care unit [Срок оценки: Through study completion (up to 5 years)]
• Survival post-arrest [Срок оценки: Up to 5 years]
• Recurrent cardiac arrest(s) [Срок оценки: Up to 5 years]
• ICD implant post-arrest [Срок оценки: Up to 5 years]