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    Clinical Trial Results:
    Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug administration In Cardiac arrest

    Summary
    EudraCT number
    2014-000792-11
    Trial protocol
    GB  
    Global end of trial date
    04 Jul 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    18 Jul 2020
    First version publication date
    18 Jul 2020
    Other versions
    Summary report(s)
    A Randomized Trial of Epinephrine in out-of-hospital cardiac arrest

    Trial information

    Close Top of page
    Trial identification
    Sponsor protocol code
    REGO-2014-612
    Additional study identifiers
    ISRCTN number
    ISRCTN73485024
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    University of Warwick
    Sponsor organisation address
    Gibbet Hill Raod, Coventry, United Kingdom,
    Public contact
    Prof Gavin Perkins, University of Warwick, 0044 02476550479, g.d.perkins@warwick.ac.uk
    Scientific contact
    Prof Gavin Perkins, University of Warwick, 0044 02476550479, g.d.perkins@warwick.ac.uk
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    27 Mar 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    28 Oct 2017
    Global end of trial reached?
    Yes
    Global end of trial date
    04 Jul 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To determine the clinical effectiveness of adrenaline in the treatment of out of hospital cardiac arrest, measured as survival to 30 days.
    Protection of trial subjects
    primary outcome-survival to 30 days. Adverse events and Serious adverse events.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    23 Dec 2014
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Efficacy, Scientific research
    Long term follow-up duration
    12 Months
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 8014
    Worldwide total number of subjects
    8014
    EEA total number of subjects
    8014
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    23
    Adults (18-64 years)
    2656
    From 65 to 84 years
    3882
    85 years and over
    1453

    Subject disposition

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    Recruitment
    Recruitment details
    From December 2014 through October 2017, the multicenter, randomized, double-blind, placebo controlled PARAMEDIC2 trial was conducted by five National Health Service ambulance services in the United Kingdom.

    Pre-assignment
    Screening details
    Inclusion criteria: Out-of-hospital cardiac arrest; Advanced life support initiated and/or continued by ambulance service clinician. Exclusion criteria: Known or apparent pregnancy or <16 years; Cardiac arrest caused by anaphylaxis or life threatening asthma; Adrenaline given prior to ambulance service clinician arrival; traumatic arrest (London)

    Pre-assignment period milestones
    Number of subjects started
    10623 [1]
    Intermediate milestone: Number of subjects
    Pack opened, before drug was given: 8103
    Intermediate milestone: Number of subjects
    Pack opened, drug was given: 8016
    Number of subjects completed
    8014

    Pre-assignment subject non-completion reasons
    Reason: Number of subjects
    Known or suspected to be <16 years of age: 268
    Reason: Number of subjects
    Known or suspected to be pregnant: 17
    Reason: Number of subjects
    Had return of spontaneous circulation: 615
    Reason: Number of subjects
    Had cardiac arrest secondary to anaphylaxis: 17
    Reason: Number of subjects
    Had CA secondary to life-threatening asthma: 183
    Reason: Number of subjects
    Received adrenaline before ambulance arrival: 1192
    Reason: Number of subjects
    Had traumatic arrest (London): 228
    Reason: Number of subjects
    Found to be pregnant after pack opened: 2
    Reason: Number of subjects
    Found to have ROSC after pack opened: 22
    Reason: Number of subjects
    Found do-not-resuscitate order after pack opened: 4
    Reason: Number of subjects
    Found to Have asthma after pack opened: 6
    Reason: Number of subjects
    Broken or contaminated syringes after pack opened: 4
    Reason: Number of subjects
    Found no intravenous access after pack opened: 2
    Reason: Number of subjects
    Had unknown reason after pack opened: 47
    Reason: Number of subjects
    Randomised but lost pack number (allocation info): 2
    Notes
    [1] - The number of subjects reported to have started the pre-assignment period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: 10623 patients were assessed for eligibility. After excluding those ineligible patients, there were 8014 patients enrolled and given the trial drug.
    Period 1
    Period 1 title
    Pre-hospital
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer, Assessor
    Blinding implementation details
    Unblinded data were only presented to the Data Monitoring Committee. The Trial Steering Committee were given blinded summary.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Adrenaline
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Experimental

    Investigational medicinal product name
    Adrenaline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Arm title
    Placebo
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Placebo

    Investigational medicinal product name
    Saline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Number of subjects in period 1
    Adrenaline Placebo
    Started
    4015
    3999
    Completed
    4015
    3999
    Period 2
    Period 2 title
    Hospital discharge
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer, Assessor
    Blinding implementation details
    Unblinded data were only presented to the Data Monitoring Committee. The Trial Steering Committee were given blinded summary.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Adrenaline
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Experimental

    Investigational medicinal product name
    Adrenaline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intravenous use, Intraosseous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Arm title
    Placebo
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Placebo

    Investigational medicinal product name
    Saline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Number of subjects in period 2
    Adrenaline Placebo
    Started
    4015
    3999
    Completed
    4015
    3999
    Period 3
    Period 3 title
    30 days post randomisation
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer, Assessor
    Blinding implementation details
    Unblinded data were only presented to the Data Monitoring Committee. The Trial Steering Committee were given blinded summary.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Adrenaline
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Experimental

    Investigational medicinal product name
    Adrenaline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Arm title
    Placebo
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Placebo

    Investigational medicinal product name
    Saline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Number of subjects in period 3
    Adrenaline Placebo
    Started
    4015
    3999
    Completed
    4015
    3999
    Period 4
    Period 4 title
    3 months post randomisation
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer, Assessor
    Blinding implementation details
    Unblinded data were only presented to the Data Monitoring Committee. The Trial Steering Committee were given blinded summary.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Adrenaline
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Experimental

    Investigational medicinal product name
    Adrenaline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Arm title
    Placebo
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Placebo

    Investigational medicinal product name
    Saline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Number of subjects in period 4
    Adrenaline Placebo
    Started
    4015
    3999
    Completed
    4015
    3999
    Period 5
    Period 5 title
    6 months post randomisation
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer, Assessor
    Blinding implementation details
    Unblinded data were only presented to the Data Monitoring Committee. The Trial Steering Committee were given blinded summary.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Adrenaline
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Experimental

    Investigational medicinal product name
    Adrenaline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Arm title
    Placebo
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Placebo

    Investigational medicinal product name
    Saline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Number of subjects in period 5
    Adrenaline Placebo
    Started
    4015
    3999
    Completed
    4015
    3999
    Period 6
    Period 6 title
    12 months post randomisation
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer, Assessor
    Blinding implementation details
    Unblinded data were only presented to the Data Monitoring Committee. The Trial Steering Committee were given blinded summary.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Adrenaline
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Experimental

    Investigational medicinal product name
    Adrenaline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Arm title
    Placebo
    Arm description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Arm type
    Placebo

    Investigational medicinal product name
    Saline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intraosseous use, Intravenous use
    Dosage and administration details
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of epinephrine (adrenaline) or 0.9% saline. Single doses of epinephrine or saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Number of subjects in period 6
    Adrenaline Placebo
    Started
    4015
    3999
    Completed
    4015
    3999

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Adrenaline
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Reporting group title
    Placebo
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Reporting group values
    Adrenaline Placebo Total
    Number of subjects
    4015 3999 8014
    Age categorical
    Units: Subjects
        Adolescents (12-17 years)
    8 6 14
        Adults (18-64 years)
    1345 1311 2656
        From 65-84 years
    1923 1959 3882
        85 years and over
    735 718 1453
        Missing
    4 5 9
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    69.7 ( 16.6 ) 69.8 ( 16.4 ) -
    Gender categorical
    Units: Subjects
        Female
    1406 1415 2821
        Male
    2609 2584 5193
    Initial cardiac rhythm
    Units: Subjects
        Ventricular fibrillation
    716 684 1400
        Pulseless ventricular tachycardia
    25 20 45
        Asystole
    2135 2194 4329
        Pulseless electrical activity
    955 937 1892
        Bradycardia
    20 16 36
        Not otherwise identified with AED (Nonshockable)
    39 34 73
        Not otherwise identified with AED (Shockable)
    29 44 73
        Not identified
    4 1 5
        Missing
    92 69 161
    Cause of cardiac arrest
    Units: Subjects
        Medical cause
    3656 3691 7347
        Traumatic cause
    66 57 123
        Drowning
    10 10 20
        Drug overdose
    74 72 146
        Electrocution
    0 1 1
        Asphyxia
    117 81 198
        Not identified
    1 2 3
        Missing
    91 85 176
    Witness of cardiac arrest
    Units: Subjects
        None
    1498 1505 3003
        Paramedic
    452 470 922
        Bystander
    2013 1967 3980
        Not identified
    1 1 2
        Missing
    51 56 107
    CPR performed
    Units: Subjects
        By bystander
    2382 2349 4731
        By paramedic during witnessed event
    452 471 923
        Not identified
    1 1 2
        Missing
    69 84 153
        Not performed
    1111 1094 2205
    Return of spontaneous circulation
    Units: Subjects
        Yes
    1457 468 1925
        No
    2518 3492 6010
        Missing
    40 39 79
    Transportation of patient to hospital
    Units: Subjects
        Yes
    2041 1227 3268
        No
    1974 2772 4746
    Declaration of death by emergency department staff
    Units: Subjects
        Yes
    988 689 1677
        No
    614 290 904
        Not applicable because not transported
    1974 2772 4746
        Missing
    439 248 687
    Interval between emergency call and ambulance arrival at scene
    Units: minute
        median (inter-quartile range (Q1-Q3))
    6.7 (4.3 to 9.7) 6.6 (4.2 to 9.6) -
    Interval between emergency call and administration of trial agent
    Units: minute
        median (inter-quartile range (Q1-Q3))
    21.5 (16.0 to 27.3) 21.1 (16.1 to 27.4) -
    Interval between ambulance arrival at scene and departure
    Units: minute
        arithmetic mean (standard deviation)
    50.1 ( 21.8 ) 44.5 ( 18.3 ) -
    Median interval between initiation of advanced life support and cessation
    Units: minute
        median (inter-quartile range (Q1-Q3))
    47.5 (35.1 to 64.0) 43.1 (33.5 to 56.1) -

    End points

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    End points reporting groups
    Reporting group title
    Adrenaline
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Reporting group title
    Placebo
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Reporting group title
    Adrenaline
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Reporting group title
    Placebo
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Reporting group title
    Adrenaline
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Reporting group title
    Placebo
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Reporting group title
    Adrenaline
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Reporting group title
    Placebo
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Reporting group title
    Adrenaline
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Reporting group title
    Placebo
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.
    Reporting group title
    Adrenaline
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Reporting group title
    Placebo
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Primary: Survival at 30 days

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    End point title
    Survival at 30 days
    End point description
    End point type
    Primary
    End point timeframe
    30 days post randomisation
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    4015
    3999
    Units: Number of survivors
        Survived
    130
    94
        Deceased
    3882
    3901
    Statistical analysis title
    Secondary analysis
    Statistical analysis description
    Adjusted for patients’ age, sex, interval between emergency call and ambulance arrival at scene, interval between ambulance arrival at scene and administration of the trial agent, initial cardiac rhythm, cause of cardiac arrest, whether the cardiac arrest was witnessed, and whether CPR was performed by a bystander.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8014
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.47
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.09
         upper limit
    1.97
    Statistical analysis title
    Primary analysis
    Statistical analysis description
    Unadjusted analysis
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8014
    Analysis specification
    Pre-specified
    Analysis type
    superiority [1]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.39
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.06
         upper limit
    1.82
    Notes
    [1] - Unadjusted analysis.

    Secondary: Survival event (sustained return of spontaneous circulation (ROSC))

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    End point title
    Survival event (sustained return of spontaneous circulation (ROSC))
    End point description
    End point type
    Secondary
    End point timeframe
    Until admission and transfer of care to medical staff at the receiving hospital.
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    4015
    3999
    Units: Number of patients achieved ROSC
        Yes
    947
    319
        No
    3026
    3663
        Unknown
    42
    17
    Statistical analysis title
    ROSC at hospital admission - unadjusted
    Comparison groups
    Placebo v Adrenaline
    Number of subjects included in analysis
    8014
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    3.59
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    3.14
         upper limit
    4.12
    Statistical analysis title
    ROSC at hospital admission - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8014
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    3.83
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    3.3
         upper limit
    4.43

    Secondary: Survival to hospital discharge

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    End point title
    Survival to hospital discharge
    End point description
    End point type
    Secondary
    End point timeframe
    The point at which the patient is discharged from the hospital acute care unit regardless of neurological status, outcome or destination.
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    4015
    3999
    Units: Number of patients survived
        Survived
    128
    91
        Deceased
    3881
    3904
        Unknown
    6
    4
    Statistical analysis title
    Survival to hospital discharge - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8014
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.41
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.08
         upper limit
    1.86
    Statistical analysis title
    Survival to hospital discharge - adjusted
    Statistical analysis description
    Analysis was adjusted for patients’ age, sex, interval between emergency call and ambulance arrival at scene, interval between ambulance arrival at scene and administration of the trial agent, initial cardiac rhythm, cause of cardiac arrest, whether the cardiac arrest was witnessed, and whether CPR was performed by a bystander.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8014
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.48
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.1
         upper limit
    2

    Secondary: Intensive care length of stay (survivors)

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    End point title
    Intensive care length of stay (survivors)
    End point description
    End point type
    Secondary
    End point timeframe
    From randomisation up to the first ICU discharge. Recurrent ICU admissions are not counted.
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    146 [2]
    92 [3]
    Units: Days
        median (inter-quartile range (Q1-Q3))
    7.5 (3.0 to 15.0)
    7.0 (3.5 to 12.5)
    Notes
    [2] - ICU survivors
    [3] - ICU survivors
    No statistical analyses for this end point

    Secondary: Hospital length of stay (survivors)

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    End point title
    Hospital length of stay (survivors)
    End point description
    End point type
    Secondary
    End point timeframe
    From randomisation up to hospital discharge.
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    127
    91
    Units: Days
        median (inter-quartile range (Q1-Q3))
    21 (10 to 41)
    20 (9 to 38)
    No statistical analyses for this end point

    Secondary: Hospital free survival in 30 days post randomisation

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    End point title
    Hospital free survival in 30 days post randomisation
    End point description
    Summary of days of free of hospital stay within the first 30 days survival or before death, whichever is sooner.
    End point type
    Secondary
    End point timeframe
    30 days post randomisation.
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    4007
    3993
    Units: Days
        arithmetic mean (standard deviation)
    0.3 ( 2.5 )
    0.2 ( 2.2 )
    No statistical analyses for this end point

    Secondary: ICU free survival in 30 days post randomisation

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    End point title
    ICU free survival in 30 days post randomisation
    End point description
    Summary of days of free of ICU stay within the first 30 days survival or before death, whichever is sooner
    End point type
    Secondary
    End point timeframe
    30 days post randomisation
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    4006
    3993
    Units: Days
        arithmetic mean (standard deviation)
    0.8 ( 4.1 )
    0.5 ( 3.6 )
    No statistical analyses for this end point

    Secondary: Survival at 3 months

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    End point title
    Survival at 3 months
    End point description
    End point type
    Secondary
    End point timeframe
    3 months post randomisation
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    4009
    3991
    Units: Number of patients survived
        Survived
    121
    86
        Deceased
    3888
    3905
    Statistical analysis title
    Survival at 3 months - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8000
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.41
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.07
         upper limit
    1.87
    Statistical analysis title
    Survival at 3 months - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8000
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.47
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.08
         upper limit
    2

    Secondary: Survival at 6 months

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    End point title
    Survival at 6 months
    End point description
    End point type
    Secondary
    End point timeframe
    6 months post randomisation
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    4006
    3991
    Units: Number of patients survived
        Survived
    117
    85
        Deceased
    3889
    3906
    Statistical analysis title
    Survival at 6 months - unadjusted
    Comparison groups
    Placebo v Adrenaline
    Number of subjects included in analysis
    7997
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.38
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.04
         upper limit
    1.83
    Statistical analysis title
    Survival at 6 months - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7997
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.43
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.05
         upper limit
    1.96

    Secondary: Survival at 12 months

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    End point title
    Survival at 12 months
    End point description
    End point type
    Secondary
    End point timeframe
    12 months post randomisation
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    4006
    3991
    Units: Number of patients survived
        Survived
    107
    80
        Deceased
    3899
    3911
    Statistical analysis title
    Survival at 12 months - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7997
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.34
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1
         upper limit
    1.8
    Statistical analysis title
    Survival at 12 months - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7997
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.38
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1
         upper limit
    1.92

    Secondary: modified Rankin Scale at hospital discharge

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    End point title
    modified Rankin Scale at hospital discharge
    End point description
    mRS score is measured on a 7-point scale (from 0 (no symptom) to 6 (dead)). It is also summarised in binary category: Good (0-3) and Poor (4-6).
    End point type
    Secondary
    End point timeframe
    At hospital discharge
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    4007
    3994
    Units: mRS score
        0 - No symptoms
    12
    15
        1 - No significant disability
    17
    10
        2 - Slight disability
    23
    29
        3 - Moderate disability
    35
    20
        4 - Moderately severe disability
    12
    8
        5 - Severe disability
    27
    8
        6 - Dead
    3881
    3904
    Attachments
    mRS at hospital discharge
    Statistical analysis title
    mRS at discharge - unadjusted 0vs1-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [4]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.797
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.373
         upper limit
    1.704
    Notes
    [4] - Results are listed separately. This record shows the odds of (0) vs odds of (1-6)
    Statistical analysis title
    mRS at discharge - unadjusted 0-1vs2-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Placebo v Adrenaline
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [5]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.157
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.677
         upper limit
    1.98
    Notes
    [5] - Results are listed separately. This record shows the odds of (0-1) vs odds of (2-6)
    Statistical analysis title
    mRS at discharge - unadjusted 0-2vs3-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [6]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.959
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.654
         upper limit
    1.407
    Notes
    [6] - Results are listed separately. This record shows the odds of (0-2) vs odds of (3-6)
    Statistical analysis title
    mRS at discharge - unadjusted 0-3vs4-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [7]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.176
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.86
         upper limit
    1.608
    Notes
    [7] - Results are listed separately. This record shows the odds of (0-3) vs odds of (4-6)
    Statistical analysis title
    mRS at discharge - unadjusted 0-4vs5-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [8]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.209
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.899
         upper limit
    1.625
    Notes
    [8] - Results are listed separately. This record shows the odds of (0-4) vs odds of (5-6)
    Statistical analysis title
    mRS at discharge - unadjusted 0-5vs6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [9]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.408
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.071
         upper limit
    1.852
    Notes
    [9] - Results are listed separately. This record shows the odds of (0-5) vs odds of (6)
    Statistical analysis title
    mRS at discharge - adjusted 0vs1-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [10]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.796
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.358
         upper limit
    1.769
    Notes
    [10] - Results are listed separately. This record shows the odds of (0) vs odds of (1-6)
    Statistical analysis title
    mRS at discharge - adjusted 0-1vs2-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [11]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.156
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.658
         upper limit
    2.029
    Notes
    [11] - Results are listed separately. This record shows the odds of (0-1) vs odds of (2-6)
    Statistical analysis title
    mRS at discharge - adjusted 0-2vs3-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Placebo v Adrenaline
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [12]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.98
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.651
         upper limit
    1.476
    Notes
    [12] - Results are listed separately. This record shows the odds of (0-2) vs odds of (3-6)
    Statistical analysis title
    mRS at discharge - adjusted 0-3vs4-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [13]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.231
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.878
         upper limit
    1.727
    Notes
    [13] - Results are listed separately. This record shows the odds of (0-3) vs odds of (4-6)
    Statistical analysis title
    mRS at discharge - adjusted 0-4vs5-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [14]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.263
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.914
         upper limit
    1.745
    Notes
    [14] - Results are listed separately. This record shows the odds of (0-4) vs odds of (5-6)
    Statistical analysis title
    mRS at discharge - adjusted 0-5vs6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority [15]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.508
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.115
         upper limit
    2.039
    Notes
    [15] - Results are listed separately. This record shows the odds of (0-5) vs odds of (6)

    Secondary: modified Rankin Scale at 3 months

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    End point title
    modified Rankin Scale at 3 months
    End point description
    mRS score is measured on a 7-point scale (from 0 (no symptom) to 6 (dead)). It is also summarised in binary category: Good (0-3) and Poor (4-6).
    End point type
    Secondary
    End point timeframe
    at 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    3986
    3979
    Units: mRS score
        0 - No symptoms
    20
    20
        1 - No significant disability
    30
    20
        2 - Slight disability
    10
    11
        3 - Moderate disability
    22
    12
        4 - Moderately severe disability
    6
    5
        5 - Severe disability
    10
    6
        6 - Dead
    3888
    3905
    Statistical analysis title
    mRS at 3 months - unadjusted
    Comparison groups
    Placebo v Adrenaline
    Number of subjects included in analysis
    7965
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.328
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.979
         upper limit
    1.801
    Statistical analysis title
    mRS at 3 months - adjusted 0vs1-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7965
    Analysis specification
    Pre-specified
    Analysis type
    superiority [16]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.204
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.623
         upper limit
    2.325
    Notes
    [16] - Results are listed separately. This record shows the odds of (0) vs odds of (1-6)
    Statistical analysis title
    mRS at 3 months - adjusted 0-1vs2-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7965
    Analysis specification
    Pre-specified
    Analysis type
    superiority [17]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.394
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.889
         upper limit
    2.184
    Notes
    [17] - Results are listed separately. This record shows the odds of (0-1) vs odds of (2-6)
    Statistical analysis title
    mRS at 3 months - adjusted 0-2vs3-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7965
    Analysis specification
    Pre-specified
    Analysis type
    superiority [18]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.267
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.845
         upper limit
    1.9
    Notes
    [18] - Results are listed separately. This record shows the odds of (0-2) vs odds of (3-6)
    Statistical analysis title
    mRS at 3 months - adjusted 0-3vs4-6
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7965
    Analysis specification
    Pre-specified
    Analysis type
    superiority [19]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.413
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.986
         upper limit
    2.025
    Notes
    [19] - Results are listed separately. This record shows the odds of (0-3) vs odds of (4-6)
    Statistical analysis title
    mRS at 3 months - adjusted 0-4vs5-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7965
    Analysis specification
    Pre-specified
    Analysis type
    superiority [20]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.405
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.992
         upper limit
    1.99
    Notes
    [20] - Results are listed separately. This record shows the odds of no symptom (0-4) vs odds of death (5-6)
    Statistical analysis title
    mRS at 3 months - adjusted 0-5vs6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7965
    Analysis specification
    Pre-specified
    Analysis type
    superiority [21]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.448
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.038
         upper limit
    2.02
    Notes
    [21] - Results are listed separately. This record shows the odds of (0-5) vs odds of (6)

    Secondary: modified Rankin Scale at 6 months

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    End point title
    modified Rankin Scale at 6 months
    End point description
    mRS score is measured on a 7-point scale (from 0 (no symptom) to 6 (dead)). It is also summarised in binary category: Good (0-3) and Poor (4-6).
    End point type
    Secondary
    End point timeframe
    at 6 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    3990
    3973
    Units: mRS score
        0 - No symptoms
    25
    19
        1 - No significant disability
    22
    13
        2 - Slight disability
    10
    9
        3 - Moderate disability
    21
    17
        4 - Moderately severe disability
    7
    2
        5 - Severe disability
    16
    7
        6 - Dead
    3889
    3906
    Statistical analysis title
    mRS at 6 months - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7963
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.51
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.11
         upper limit
    2.06
    Statistical analysis title
    mRS at 6 months - adjusted 0vs1-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7963
    Analysis specification
    Pre-specified
    Analysis type
    superiority [22]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.38
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.73
         upper limit
    2.62
    Notes
    [22] - Results are listed separately. This record shows the odds of (0) vs odds of (1-6)
    Statistical analysis title
    mRS at 6 months - adjusted 0-1vs2-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Placebo v Adrenaline
    Number of subjects included in analysis
    7963
    Analysis specification
    Pre-specified
    Analysis type
    superiority [23]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.63
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.01
         upper limit
    2.65
    Notes
    [23] - Results are listed separately. This record shows the odds of (0-1) vs odds of (2-6)
    Statistical analysis title
    mRS at 6 months - adjusted 0-2vs3-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7963
    Analysis specification
    Pre-specified
    Analysis type
    superiority [24]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.47
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.95
         upper limit
    2.26
    Notes
    [24] - Results are listed separately. This record shows the odds of (0-2) vs odds of (3-6)
    Statistical analysis title
    mRS at 6 months - adjusted 0-3vs4-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7963
    Analysis specification
    Pre-specified
    Analysis type
    superiority [25]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.96
         upper limit
    2.03
    Notes
    [25] - Results are listed separately. This record shows the odds of (0-3) vs odds of (4-6)
    Statistical analysis title
    mRS at 6 months - adjusted 0-4vs5-6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7963
    Analysis specification
    Pre-specified
    Analysis type
    superiority [26]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.49
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.04
         upper limit
    2.15
    Notes
    [26] - Results are listed separately. This record shows the odds of (0-4) vs odds of (5-6)
    Statistical analysis title
    mRS at 6 months - adjusted 0-5vs6
    Statistical analysis description
    Partial proportional odds logistic regression. Ordinal proportional odds assumption violated.
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7963
    Analysis specification
    Pre-specified
    Analysis type
    superiority [27]
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.62
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.15
         upper limit
    2.28
    Notes
    [27] - Results are listed separately. This record shows the odds of (0-5) vs odds of (6)

    Secondary: Favourable neurological outcome at hospital discharge

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    End point title
    Favourable neurological outcome at hospital discharge
    End point description
    mRS score is measured on a 7-point scale (from 0 (no symptom) to 6 (dead)). It is also summarised in binary category: Good (0-3) and Poor (4-6).
    End point type
    Secondary
    End point timeframe
    at hospital discharge
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    4007
    3994
    Units: Numbers of patients with mRS 0-3
        Favourable
    87
    74
        Not favourable
    3920
    3920
    Statistical analysis title
    Favourable neurological outcome - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.18
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.86
         upper limit
    1.61
    Statistical analysis title
    Favourable neurological outcome - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    8001
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Mean difference (final values)
    Point estimate
    1.19
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.85
         upper limit
    1.68

    Secondary: Favourable neurological outcome at 3 months

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    End point title
    Favourable neurological outcome at 3 months
    End point description
    mRS score is measured on a 7-point scale (from 0 (no symptom) to 6 (dead)). It is also summarised in binary category: Good (0-3) and Poor (4-6).
    End point type
    Secondary
    End point timeframe
    at 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    3986
    3979
    Units: Number of patients with mRS 0-3
        Favourable
    82
    63
        Not favourable
    3904
    3916
    Statistical analysis title
    Favourable neurological outcome 3m - unadjusted
    Comparison groups
    Placebo v Adrenaline
    Number of subjects included in analysis
    7965
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.31
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.94
         upper limit
    1.82
    Statistical analysis title
    Favourable neurological outcome 3m - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7965
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.39
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.97
         upper limit
    2.01

    Secondary: Favourable neurological outcome at 6 months

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    End point title
    Favourable neurological outcome at 6 months
    End point description
    mRS score is measured on a 7-point scale (from 0 (no symptom) to 6 (dead)). It is also summarised in binary category: Good (0-3) and Poor (4-6).
    End point type
    Secondary
    End point timeframe
    at 6 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    3990
    3973
    Units: Number of patients with mRS 0-3
        Favourable
    78
    58
        Not favourable
    3912
    3915
    Statistical analysis title
    Favourable neurological outcome 6m - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7963
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.35
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.96
         upper limit
    1.9
    Statistical analysis title
    Favourable neurological outcome 6m - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    7963
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.35
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.93
         upper limit
    1.97

    Secondary: SF-12 Physical health at 3 months

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    End point title
    SF-12 Physical health at 3 months
    End point description
    As in the SF-12 manual: How to Score version 2 of the SF-12 Health Survey.
    End point type
    Secondary
    End point timeframe
    at 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    77
    60
    Units: point
        arithmetic mean (standard deviation)
    39.5 ( 12.6 )
    42.6 ( 11.6 )
    Statistical analysis title
    SF12 physical health at 3m - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    137
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -3.1
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -7.25
         upper limit
    1.04
    Statistical analysis title
    SF12 physical health at 3m - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    137
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -2.03
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -6.43
         upper limit
    2.36

    Secondary: SF-12 Mental health at 3 months

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    End point title
    SF-12 Mental health at 3 months
    End point description
    End point type
    Secondary
    End point timeframe
    at 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    77
    60
    Units: point
        arithmetic mean (standard deviation)
    48.8 ( 9.8 )
    50.0 ( 10.5 )
    Statistical analysis title
    SF12 mental health at 3m - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    137
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -1.18
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -4.63
         upper limit
    2.28
    Statistical analysis title
    SF12 mental health at 3m - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    137
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -1.83
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -5.32
         upper limit
    1.66

    Secondary: SF-12 Physical health at 6 months

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    End point title
    SF-12 Physical health at 6 months
    End point description
    End point type
    Secondary
    End point timeframe
    at 6 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    69
    47
    Units: point
        arithmetic mean (standard deviation)
    39.8 ( 12.6 )
    40.5 ( 11.9 )
    Statistical analysis title
    SF12 physical health at 6m - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    116
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.62
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -5.24
         upper limit
    4
    Statistical analysis title
    SF12 physical health at 6m - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    116
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -1.2
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -5.67
         upper limit
    3.28

    Secondary: SF-12 Mental health at 6 months

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    End point title
    SF-12 Mental health at 6 months
    End point description
    End point type
    Secondary
    End point timeframe
    at 6 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    69
    47
    Units: point
        arithmetic mean (standard deviation)
    43.6 ( 13.0 )
    46.5 ( 13.1 )
    Statistical analysis title
    SF12 mental health at 6m - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    116
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -2.89
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -7.76
         upper limit
    1.98
    Statistical analysis title
    SF12 mental health at 6m - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    116
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -2.44
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -7.5
         upper limit
    2.62

    Secondary: EQ-5D-5L index score at 3 months

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    End point title
    EQ-5D-5L index score at 3 months
    End point description
    End point type
    Secondary
    End point timeframe
    at 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    89
    65
    Units: point
        arithmetic mean (standard deviation)
    0.6 ( 0.4 )
    0.7 ( 0.3 )
    Statistical analysis title
    EQ-5D-5L index score at 3m - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    154
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.08
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.19
         upper limit
    0.04
    Statistical analysis title
    EQ-5D-5L index score at 3m - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    154
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.05
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.16
         upper limit
    0.06

    Secondary: EQ-5D-5L VAS score at 3 months

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    End point title
    EQ-5D-5L VAS score at 3 months
    End point description
    End point type
    Secondary
    End point timeframe
    at 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    88
    65
    Units: point
        arithmetic mean (standard deviation)
    59.8 ( 25.1 )
    66.0 ( 24.8 )
    Statistical analysis title
    EQ-5D-5L VAS at 3m - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    153
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -6.25
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -14.32
         upper limit
    1.83
    Statistical analysis title
    EQ-5D-5L VAS at 3m - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    153
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -5.08
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -13.37
         upper limit
    3.22

    Secondary: EQ-5D-5L VAS at 6 months

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    End point title
    EQ-5D-5L VAS at 6 months
    End point description
    End point type
    Secondary
    End point timeframe
    at 6 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    77
    49
    Units: point
        arithmetic mean (standard deviation)
    66.1 ( 26.0 )
    70.7 ( 26.0 )
    Statistical analysis title
    EQ-5D-5L VAS at 6m - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    126
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -4.55
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -13.96
         upper limit
    4.86
    Statistical analysis title
    EQ-5D-5L VAS at 6m - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    126
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -4.15
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -13.52
         upper limit
    5.23

    Secondary: EQ-5D-5L index score at 6 months

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    End point title
    EQ-5D-5L index score at 6 months
    End point description
    End point type
    Secondary
    End point timeframe
    at 6 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    76
    49
    Units: point
        arithmetic mean (standard deviation)
    0.6 ( 0.4 )
    0.7 ( 0.3 )
    Statistical analysis title
    EQ-5D-5L index score at 6m - unadjusted
    Comparison groups
    Placebo v Adrenaline
    Number of subjects included in analysis
    125
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.09
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.23
         upper limit
    0.05
    Statistical analysis title
    EQ-5D-5L index score at 6m - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    125
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.07
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.21
         upper limit
    0.07

    Secondary: Informant Questionnaire on Cognitive Decline in the Elderly at 3 months

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    End point title
    Informant Questionnaire on Cognitive Decline in the Elderly at 3 months
    End point description
    End point type
    Secondary
    End point timeframe
    at 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    77
    55
    Units: point
        arithmetic mean (standard deviation)
    3.3 ( 0.7 )
    3.4 ( 0.7 )
    Statistical analysis title
    IQCODE at 3 months - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    132
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.03
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.29
         upper limit
    0.23
    Statistical analysis title
    IQCODE at 3 months - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    132
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.01
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.28
         upper limit
    0.26

    Secondary: Informant Questionnaire on Cognitive Decline in the Elderly at 6 months

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    End point title
    Informant Questionnaire on Cognitive Decline in the Elderly at 6 months
    End point description
    End point type
    Secondary
    End point timeframe
    at 6 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    73
    48
    Units: point
        arithmetic mean (standard deviation)
    3.1 ( 1.1 )
    3.2 ( 0.9 )
    Statistical analysis title
    IQCODE at 6 months - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    121
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.1
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.48
         upper limit
    0.28
    Statistical analysis title
    IQCODE at 6 months - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    121
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.07
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.45
         upper limit
    0.31

    Secondary: Two simple questions Q1 at 3 months

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    End point title
    Two simple questions Q1 at 3 months
    End point description
    End point type
    Secondary
    End point timeframe
    at 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    89
    65
    Units: number of patients
        Yes
    42
    20
        No
    47
    45
    No statistical analyses for this end point

    Secondary: Two simple questions Q1 at 6 months

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    End point title
    Two simple questions Q1 at 6 months
    End point description
    Question 1 at 6 months
    End point type
    Secondary
    End point timeframe
    at 6 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    78
    48
    Units: number of patients
        Yes
    36
    16
        No
    42
    32
    No statistical analyses for this end point

    Secondary: Mental Mini State Examination

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    End point title
    Mental Mini State Examination
    End point description
    End point type
    Secondary
    End point timeframe
    At 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    71
    52
    Units: point
        arithmetic mean (standard deviation)
    27.2 ( 3.4 )
    27.5 ( 3.1 )
    Statistical analysis title
    MMSE at 3 months - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    123
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.31
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.5
         upper limit
    0.88
    Statistical analysis title
    MMSE at 3 months - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    123
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.52
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.85
         upper limit
    0.81

    Secondary: Hospital Anxiety and Depression scale - Anxiety score

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    End point title
    Hospital Anxiety and Depression scale - Anxiety score
    End point description
    End point type
    Secondary
    End point timeframe
    at 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    82
    62
    Units: point
        arithmetic mean (standard deviation)
    6.4 ( 4.9 )
    5.3 ( 4.6 )
    Statistical analysis title
    HADS anxiety at 3 months - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    144
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    1.13
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.47
         upper limit
    2.72
    Statistical analysis title
    HADS anxiety at 3 months - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    144
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    1.2
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.39
         upper limit
    2.8

    Secondary: Hospital Anxiety and Depression scale - Depression score

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    End point title
    Hospital Anxiety and Depression scale - Depression score
    End point description
    End point type
    Secondary
    End point timeframe
    at 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    81
    61
    Units: point
        arithmetic mean (standard deviation)
    5.0 ( 4.3 )
    4.5 ( 4.4 )
    Statistical analysis title
    HADS depression at 3 months - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    142
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    0.57
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.89
         upper limit
    2.02
    Statistical analysis title
    HADS depression at 3 months - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    142
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    0.42
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.05
         upper limit
    1.88

    Secondary: Post Traumatic Stress Disorder (PTSD) civilian checklist

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    End point title
    Post Traumatic Stress Disorder (PTSD) civilian checklist
    End point description
    End point type
    Secondary
    End point timeframe
    At 3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    79
    58
    Units: point
        arithmetic mean (standard deviation)
    30.3 ( 13.1 )
    26.8 ( 12.3 )
    Statistical analysis title
    PCL-C at 3 months - unadjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    137
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    3.44
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.92
         upper limit
    7.81
    Statistical analysis title
    PCL-C at 3 months - adjusted
    Comparison groups
    Adrenaline v Placebo
    Number of subjects included in analysis
    137
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Linear
    Parameter type
    Mean difference (final values)
    Point estimate
    3.85
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.4
         upper limit
    8.11

    Secondary: Intensive care length of stay - deceased

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    End point title
    Intensive care length of stay - deceased
    End point description
    End point type
    Secondary
    End point timeframe
    From ICU admission to death in ICU
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    414 [28]
    176 [29]
    Units: day
        median (inter-quartile range (Q1-Q3))
    2 (1 to 5)
    3 (1 to 5)
    Notes
    [28] - Deceased in ICU
    [29] - Deceased in ICU
    No statistical analyses for this end point

    Secondary: Hospital length of stay (deceased)

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    End point title
    Hospital length of stay (deceased)
    End point description
    End point type
    Secondary
    End point timeframe
    From randomisation to hospital death
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    3881
    3903
    Units: day
        median (inter-quartile range (Q1-Q3))
    0 (0 to 0)
    0 (0 to 0)
    No statistical analyses for this end point

    Secondary: Two simple questions Q1a at 3 months

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    End point title
    Two simple questions Q1a at 3 months
    End point description
    subquestion if Q1 is yes at 3 months
    End point type
    Secondary
    End point timeframe
    3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    42
    20
    Units: number of patients
        Yes
    35
    17
        No
    7
    3
    No statistical analyses for this end point

    Secondary: Two simple questions Q2 at 3 months

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    End point title
    Two simple questions Q2 at 3 months
    End point description
    Question 2 at 3 months
    End point type
    Secondary
    End point timeframe
    3 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    89
    65
    Units: Number of patients
        Yes
    34
    32
        No
    55
    33
    No statistical analyses for this end point

    Secondary: Two simple questions Q1a at 6 months

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    End point title
    Two simple questions Q1a at 6 months
    End point description
    Subqeustion if Q1 is yes at 6 months
    End point type
    Secondary
    End point timeframe
    at 6 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    36
    16
    Units: Number of patients
        Yes
    30
    10
        No
    6
    6
    No statistical analyses for this end point

    Secondary: Two simple questions Q2 at 6 months

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    End point title
    Two simple questions Q2 at 6 months
    End point description
    Question 2 at 6 months
    End point type
    Secondary
    End point timeframe
    at 6 months
    End point values
    Adrenaline Placebo
    Number of subjects analysed
    78
    48
    Units: Number of patients
        Yes
    35
    25
        No
    43
    23
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    from randomisation up to hospital discharge
    Adverse event reporting additional description
    An AE is: “Any untoward medical occurrence in a patient or clinical investigation participant taking part in health care research, which does not necessarily have a causal relationship with the research”.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    Study protocol
    Dictionary version
    6.0
    Reporting groups
    Reporting group title
    Adrenaline
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing 1 mg of epinephrine (adrenaline). Single doses of epinephrine were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Reporting group title
    Placebo
    Reporting group description
    Uniquely numbered but otherwise identical-appearing trial packs contained 10 prefilled syringes, with each syringe containing either 1 mg of 0.9% saline. Single doses of saline were administered by an intravenous or intraosseous route every 3 to 5 minutes.

    Serious adverse events
    Adrenaline Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 4015 (0.00%)
    0 / 3999 (0.00%)
         number of deaths (all causes)
    3899
    3911
         number of deaths resulting from adverse events
    0
    0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Adrenaline Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    1 / 4015 (0.02%)
    1 / 3999 (0.03%)
    Cardiac disorders
    Patient fell
    Additional description: Whilst moving the patient to the ambulance, the strecher wheel came off the garden path resulting in the trolley and patient falling into the garden. At the time of completing the form there is no evidence of injury or detrement to the patient.
         subjects affected / exposed
    0 / 4015 (0.00%)
    1 / 3999 (0.03%)
         occurrences all number
    0
    1
    Equipment failure
    Additional description: The paramedic was unable to clear the patient airway successfully due to equipment failure.
         subjects affected / exposed
    1 / 4015 (0.02%)
    0 / 3999 (0.00%)
         occurrences all number
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/30391366
    http://www.ncbi.nlm.nih.gov/pubmed/30021076
    http://www.ncbi.nlm.nih.gov/pubmed/31912202
    http://www.ncbi.nlm.nih.gov/pubmed/31937351
    http://www.ncbi.nlm.nih.gov/pubmed/27650864
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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