Trial reportIntensive care medicine2020
The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial.
Trial report in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 2 syntheses or guidelines pooled it, 78 citations in OpenAlex.
- Association Between Epinephrine Administration Timing and Outcomes in Adult Out-of-Hospital Cardiac Arrest: A Systematic Review and Dose-Response Meta-Analysis.Medicina (Kaunas, Lithuania) · 2026Pooled it
- Therapeutic and adverse effects of adrenaline on patients who suffer out-of-hospital cardiac arrest: a systematic review and meta-analysis.European journal of medical research · 2023Pooled it
- Vasopressor or advanced airway first in cardiac arrest?Resuscitation · 2024Trial
- Effect of Time to Treatment With Antiarrhythmic Drugs on Return of Spontaneous Circulation in Shock-Refractory Out-of-Hospital Cardiac Arrest.Journal of the American Heart Association · 2022Trial
- Impact of nurse empowerment for early adrenaline administration for in-hospital cardiac arrest resuscitation: A pre-post intervention study.World journal of critical care medicine · 2026Article
- [Focus on emergency medicine 2024/2025 : Summary of selected studies in emergency medicine].Die Anaesthesiologie · 2026Article
- Wolf Creek XVIII Part 2: optimizing time intervals in cardiac arrest care.Resuscitation plus · 2026Review
- Adrenaline and return of spontaneous circulation during in-hospital cardiac arrest.Resuscitation plus · 2025Article
- The use of epinephrine in out-of-hospital cardiac arres : A retrospective study of the effects of administration timing and cumulative doses on outcome in a physician-staffed emergency medical service system.BMC emergency medicine · 2025Article
- A comparison of the outcomes of emergency medical service-witnessed cardiac arrest between intravenous access before and after cardiac arrest.Scientific reports · 2025Article
- Use of Epinephrine in Cardiac Arrest: Advances and Future Challenges.Medicina (Kaunas, Lithuania) · 2024Review
- Methods of Using a Manual Defibrillator during Simultaneous Cardiac Arrest in Two Patients-Analysis of the Actions of Emergency Medical Response Teams during the Championships in Emergency Medicine.Journal of clinical medicine · 2024Article
- Impact of intravenous accessibility and prehospital epinephrine use on survival outcomes of adult nontraumatic out-of-hospital cardiac arrest patients.BMC emergency medicine · 2024Article
- Article
- Route of drug administration in out-of-hospital cardiac arrest: A protocol for a randomised controlled trial (PARAMEDIC-3).Resuscitation plus · 2024Article
- Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest.JAMA network open · 2024Article
- Skeletal muscle oxygenation during cardiopulmonary resuscitation as a predictor of return of spontaneous circulation: a pilot study.European journal of medical research · 2023Article
- Intravenous vs. intraosseous vascular access during out-of-hospital cardiac arrest - protocol for a randomised clinical trial.Resuscitation plus · 2023Article
- Resuscitation Plus Special Issue: Cardiac arrest research.Resuscitation plus · 2023Article
- Improving vasopressor use in cardiac arrest.Critical care (London, England) · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 8 institutions in 2 countries.
Funding
Abstract
purposeTo examine the time to drug administration in patients with a witnessed cardiac arrest enrolled in the Pre-Hospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest (PARAMEDIC2) randomised controlled trial.
methodsThe PARAMEDIC2 trial was undertaken across 5 NHS ambulance services in England and Wales with randomisation between December 2014 and October 2017. Patients with an out-of-hospital cardiac arrest who were unresponsive to initial resuscitation attempts were randomly assigned to 1 mg intravenous adrenaline or matching placebo according to treatment packs that were identical apart from treatment number. Participants and study staff were masked to treatment allocation.
results8016 patients were enrolled, 4902 sustained a witnessed cardiac arrest of whom 2437 received placebo and 2465 received adrenaline. The odds of return of spontaneous circulation decreased in both groups over time but at a greater rate in the placebo arm odds ratio (OR) 0.93 (95% CI 0.92-0.95) compared with the adrenaline arm OR 0.96 (95% CI 0.95-0.97); interaction OR: 1.03, 95% CI 1.01-1.05, p = 0.005. By contrast, although the rate of survival and favourable neurological outcome decreased as time to treatment increased, the rates did not differ between the adrenaline and placebo groups.
conclusionThe rate of return of spontaneous circulation, survival and favourable neurological outcomes decrease over time. As time to drug treatment increases, adrenaline increases the chances of return of spontaneous circulation. Longer term outcomes were not affected by the time to adrenaline administration. (ISRCTN73485024).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.