Journal Club Summary: A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest

Methodology Score: 4/5
Usefulness Score: 3.5/5

Perkins GD, et al N Engl J Med. 2018 Jul 18.

Editorial:  Testing Epinephrine for Out-of-Hospital Cardiac Arrest. Callaway CW, et al. N Engl J Med. 2018 Jul 18.

Question and Methods: Multicenter, randomized, double-blind, placebo-controlled trial sought to determine the safety and effectiveness of epinephrine in Out-of-Hospital Cardiac Arrest.

Findings: Epinephrine resulted in a significantly higher rate of survival at 30 days (NNT= 112), but there was no between group difference in the rate of a favorable neurologic outcome (OR 1.18; 95% CI, 0.86 to 1.61).

Limitations: Limited information provided regarding pre-existing neurologic status, CPR quality, and hospital-based care.

Interpretation: This study adds to the literature that epinephrine in OHCA is not effective at improving survival with favorable neurologic outcome although clinicians should continue to follow local cardiac arrest guidelines.

By: Dr. Jeff Landreville

Related Blog Entries: Prehospital Advanced Cardiac Life Support for Out-of-hospital Cardiac Arrest: A Cohort Study.
Beyond the guidelines: an approach to cardiac arrest in the Emergency Department

Epi Lesson: Concealment versus Blinding

These clinical trial terms have different meanings but are often confused. Concealment refers to the process whereby the treatment allocation is made unknown or concealed prior to patient randomization. This helps prevent selection bias by ensuring that health providers and research staff are not tempted to include or exclude cases according to their views on the allocated treatment. Blinding refers to the methods employed after randomization to ensure that patients, health care providers, and research staff cannot determine whether the patient is receiving the study or the control treatment. This reduces ascertainment bias (the likelihood of differential assessment of outcome).
By: Dr. Ian Stiell