The "Pump" (ROSC & Survival)
The rate of Return of Spontaneous Circulation (ROSC) in the Adrenaline group was approximately this, compared to 11.7% in the placebo group.
What is 36.3%? (Accept ~36%).
The trial used this specific scale to measure neurological disability at hospital discharge.
What is the Modified Rankin Scale (mRS)?
This trial was conducted across 5 NHS Ambulance Services in the UK. The median time from emergency call to drug administration was this many minutes.
What is 21 minutes?
The primary outcome measure of the study.
What is Survival at 30 days?
The prestigious journal in which these findings were published in August 2018.
What is The New England Journal of Medicine (NEJM)?
This was the Primary Outcome of the study, which showed a small but statistically significant benefit (3.2% vs 2.4%).
What is 30-day survival?
There was no significant difference between the groups for this specific favorable neurological outcome (mRS 0–3).
What is "Survival with Favorable Neurological Outcome"? (2.2% vs 1.9%).
The total number of patients enrolled in the study (to the nearest thousand).
What is 8,000? (Exact: 8,014)
The survival rate in the epinephrine group was 3.2%, compared to this rate in the placebo group.
What is 2.4%?
The study concluded that while epinephrine increases 30-day survival, it does not improve this patient-centered outcome.
What is survival with favorable neurological outcome?
While Adrenaline improved ROSC and 30-day survival, the survival rate at this specific later time point was also significantly higher in the Adrenaline group (3.0% vs 2.2%).
What is 3-month survival? (Or survival to hospital discharge).
Among the survivors, the rate of Severe Neurological Impairment (mRS 4–5) in the Adrenaline group was approximately this percentage, compared to 17.8% in the placebo group.
What is 31.0%? (Accept "Double" or ~30%).
The number of National Health Service (NHS) ambulance services in the UK that participated in the trial.
What is 5?
The Number Needed to Treat (NNT) with epinephrine to prevent one death at 30 days.
What is 112?
This international liaison committee's concerns regarding the safety and efficacy of adrenaline prompted the call for this trial.
What is ILCOR?
In the subgroup analysis based on initial rhythm, this was the finding regarding the efficacy of Adrenaline in Shockable vs. Non-Shockable rhythms.
What is "No significant difference"? (The interaction test was non-significant; the drug worked similarly across rhythms).
Physiologically, Adrenaline is thought to worsen neurological outcome because its Alpha-adrenergic effects cause this specific change in cerebral vasculature.
what is severe microvascular vasoconstriction (reduction in cerebral blood flow)?
Patients with cardiac arrest due to these two specific causes were excluded because Adrenaline is a specific antidote for the pathology.
What are Anaphylaxis and Asthma?
The unadjusted odds ratio for survival at 30 days (1.39) showed statistical significance with a P-value of this.
What is P=0.02?
The absolute risk reduction for mortality provided by epinephrine in this study.
What is 0.8%? (3.2% - 2.4%)
Of the patients who achieved ROSC in the Adrenaline group, this approximate percentage actually survived to 30 days (highlighting "Fragile ROSC").
What is ~9%? (130 survivors out of 1457 ROSC patients). Note: In placebo, the conversion rate was ~20%.
this term describes the phenomenon where a drug increases the number of survivors, but the "extra" survivors are predominantly those with severe disability.
What is the "Survival-Disability Trade-off"? (Or Survivorship Bias).
The funding body for this major UK research initiative.
What is the NIHR (National Institute for Health Research)?
Epinephrine significantly increased this immediate sign of resuscitation success, occurring in 36.3% of the treatment group vs 11.7% of placebo.
What is ROSC (Return of Spontaneous Circulation)?
PARAMEDIC2 solidified the priority of "High-quality CPR and early Defibrillation" over drugs. In the ALS algorithm, this specific timing for adrenaline in shockable rhythms remains unchanged despite the trial.
What is "after the 3rd shock"?
In the accompanying NEJM editorial by Dr. Clifton Callaway, he argued that while the data on neurological injury is concerning, we should continue to use adrenaline. His primary ethical argument was that valid neurological prognostication can only happen at this specific location/time, not on the pavement.
What is the ICU (or "In the hospital after reperfusion")? (Rationale: You cannot select who will have a good brain and who won't during arrest; therefore, you save the heart first and assess the brain later.)