Adrenaline for traumatic cardiac arrest: A post hoc analysis of the PARAMEDIC2 trial

There is controversy about the effectiveness of adrenaline in traumatic cardiac arrest. This study reports the patient characteristics and outcomes of adults with trauma-related out of hospital cardiac arrest treated with adrenaline or placebo.

This post-hoc, sub-group analysis of the Pre-hospital Randomised Assessment of Adrenaline in Cardiac Arrest-2 (PARAMEDIC-2) trial explored the effect of adrenaline on survival to hospital admission, longer-term survival and neurological outcomes amongst adults with trauma related out of hospital cardiac arrest. Individual patients were randomised through opening a single treatment pack which contained either 10 doses of 1 mg adrenaline or 0.9% saline placebo. Treating clinicians, investigators, outcome assessors and patients were blinded to treatment allocation. The primary outcome was survival to 30 days post cardiac arrest.

123 of 8,014 enrolled patients (1.5%) sustained a traumatic cardiac arrest (66 in the adrenaline arm and 57 in the placebo arm). Three times as many patients were admitted to hospital alive in the adrenaline arm 16/66 (24.2%) compared to 5/56 (8.9%) in the placebo arm, unadjusted odds ratio 3.3 (95% confidence interval 1.1 to 9.6), p = 0.03; adjusted odd ratio 5.6 (95% CI 1.6 to 20.4), p = 0.009. A single patient, in the adrenaline arm, survived beyond 30 days (1/66 (1.5%) compared to 0/57 (0%)), who also experienced a favourable neurological outcome.

Adrenaline was associated with a trebling of the rate of survival to hospital admission. These data support the use of adrenaline in trauma related out of hospital cardiac arrest.

ISRCTN73485024.