Evidence map›Paper›PMID 42260675›Full record

ArticleTrials2026

Evaluating intramuscular epinephrine in pediatric out-of-hospital cardiac arrest (the PRIME trial): study protocol for a multi-centre, stepped-wedge cluster quasi-randomized controlled trial.

Samina Idrees, Maysaa Assaf, Matthew Davis, Facundo Garcia-Bournissen, Jay Loosley, Michael R Miller, Janice A Tijssen

Registry-linked trialAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in Trials, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05166343 (Pediatric Out-of-Hospital Cardiac Arrest Resuscitation), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

NCT05166343 phase2 / phase3recruitingnot on this map

Pediatric Out-of-Hospital Cardiac Arrest Resuscitation: Evaluation of IM Epinephrine (The PRIME Trial)

TypeinterventionalSponsorLondon Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph'sRan2024 to 2029Enrolled284ConditionsPediatric Out-of-Hospital Cardiac ArrestArmsEpinephrine Injection
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Samina IdreesChildren's Health Research Institute, London Health Sciences Centre, London, ON, Canada.ORCID http://orcid.org/0009-0007-1711-3684
Maysaa AssafChildren's Health Research Institute, London Health Sciences Centre, London, ON, Canada.
Matthew DavisDivision of Emergency Medicine, Department of Medicine, London Health Sciences Centre, London, ON, Canada.
Facundo Garcia-BournissenDivision of Paediatric Clinical Pharmacology, Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Jay LoosleyDepartment of Education and Training, Middlesex-London Paramedic Service, London, ON, Canada.
Michael R MillerChildren's Health Research Institute, London Health Sciences Centre, London, ON, Canada.
Janice A TijssenChildren's Health Research Institute, London Health Sciences Centre, London, ON, Canada. janice.tijssen@lhsc.on.ca.

Funding

Academic Medical Organization of Southwestern Ontario INN22-013Heart and Stroke Foundation of Canada G-24-0036493Thrasher Research Fund 01695
6 · The paper itself

Abstract

backgroundPediatric out-of-hospital cardiac arrest (POHCA) is a time-sensitive event with a high mortality rate. Epinephrine is a key first-line medication used during cardiac arrest resuscitation to support perfusion and return of spontaneous circulation (ROSC). Guidelines for the management of POHCA recommend paramedics administer epinephrine as soon as possible by intravenous (IV) or intraosseous (IO) injection. However, successfully inserting an IV or IO line can be challenging in high-stress situations, particularly in a poorly perfused, small child. In contrast, intramuscular (IM) epinephrine, which is the standard of care in anaphylaxis management, does not require paramedics to secure vascular access and may lead to a shorter time to first dose. The POHCA Resuscitation: Evaluation of IM Epinephrine (PRIME) trial aims to evaluate the impact of IM epinephrine on POHCA outcomes. The primary objective of the PRIME trial is to determine if an initial dose of IM epinephrine improves time to return of spontaneous circulation (ROSC) compared to standard of care alone.

methodsThe PRIME trial is a prospective, multi-centre, pragmatic, two-arm, open-label, stepped-wedge cluster quasi-randomized controlled trial. We will randomize at the level of the paramedic service, as individual-level randomization is not possible due to the inclusion of multiple, heterogeneous regions. Each site will serve as its own control. This study is a regional trial, with a focus on limited efficacy testing through an intermediate outcome (i.e., time to ROSC) that is strongly associated with survival. We also aim to evaluate the impact of the intervention on survival to hospital discharge, survival to hospital discharge with favourable neurological outcome, and safety in POHCA management. DISCUSSION: The PRIME trial aims to provide insight into the effectiveness and safety of IM epinephrine in POHCA. The data and analyses generated from the trial have the potential to inform resuscitation guidelines and standard of care practices.

trial registrationClinicalTrials.gov NCT05166343, Registered on December 8, 2021.

Indexed as

Cardiopulmonary ResuscitationEpinephrineOut-of-Hospital Cardiac ArrestChildChild, PreschoolHumansInjections, IntramuscularMulticenter Studies as TopicPragmatic Clinical Trials as TopicProspective StudiesReturn of Spontaneous CirculationTime FactorsTreatment OutcomeEpinephrineEpinephrineIntramuscularPediatric out-of-hospital cardiac arrestRandomized controlled trialResuscitationROSC

Identifiers

PMID42260675
PMCPMC13471612

What OpenQuestion holds

Textmetadata
Read underepoch 390

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.