Epinephrine Dose: Optimal Versus Standard Evaluation Trial

NCT ID: NCT03826524

Last Updated: 2025-12-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

3790 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-24

Study Completion Date

2028-12-31

Brief Summary

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The objective of this randomized controlled trial is to evaluate the effectiveness of a low cumulative dose of epinephrine compared to a standard cumulative dose of epinephrine during resuscitation from ventricular fibrillation (VF) or ventricular tachycardia (VT) in adult out-of-hospital cardiac arrest (OHCA) patients.

Detailed Description

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This study is designed as a prospective, multicentre, single-blinded randomized controlled trial (RCT) where eligible OHCA patients are randomized to receive a low cumulative dose of epinephrine (low dose epinephrine, up to 2mg total) or a standard cumulative dose of epinephrine (standard dose epinephrine, up to 6mg total) in a 1:1 fashion.

Eligible OHCA patients will be treated by paramedics who will initiate cardiopulmonary resuscitation (CPR) and the delivery of defibrillation shocks per paramedic agencies' treatment protocols. After one defibrillation and when feasible, paramedics will establish peripheral intravenous (IV) access, and patients will be randomly allocated to either the low dose or standard dose treatment arm. Epinephrine doses (according to treatment assignment) will be administered every 3-5 minutes, based on current guidelines and paramedic protocols, until the first return of spontaneous circulation (ROSC) is achieved or if resuscitation has been terminated by the base hospital physician. Other medications (e.g. antiarrhythmics, magnesium, beta blockers) and interventions (e.g. intubation) may be interposed as required. Follow-up will take place using a combination of administrative databases (e.g. the Discharge Abstract Database and the National Ambulatory Care Reporting System) and telephone interviews.

This RCT will evaluate a fundamental change in the treatment of OHCA. The investigators hypothesize that a low cumulative dose of epinephrine will improve patient survival to hospital discharge compared to a standard cumulative dose of epinephrine. Please feel free to contact [email protected] for further information.

Conditions

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Cardiac Arrest, Out-Of-Hospital Sudden Cardiac Arrest Ventricular Fibrillation Ventricular Tachycardia-Pulseless

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Low Dose Epinephrine

Epinephrine up to 2mg total

Group Type ACTIVE_COMPARATOR

Epinephrine

Intervention Type DRUG

Epinephrine 1mg 1:10000 (10cc) per dose

Standard Dose Epinephrine

Epinephrine up to 6mg total

Group Type ACTIVE_COMPARATOR

Epinephrine

Intervention Type DRUG

Epinephrine 1mg 1:10000 (10cc) per dose

Interventions

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Epinephrine

Epinephrine 1mg 1:10000 (10cc) per dose

Intervention Type DRUG

Other Intervention Names

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Adrenaline

Eligibility Criteria

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Inclusion Criteria

* Out-of-hospital cardiac arrest treated by paramedics
* Initial recorded cardiac rhythm of VF or pulseless VT, or, AED shock on first analysis administered or witnessed by EMS (paramedic or fire)
* Established intravenous vascular access

Exclusion Criteria

* Known or apparent age \<18 years
* Initial recorded cardiac rhythm of VF or pulseless VT, or, AED shock on first analysis administered or confirmed by paramedics
* Cardiac arrest due to an obvious non-cardiac primary cause (e.g. blunt or penetrating trauma, exsanguination, burns, drug overdose, drowning, anaphylaxis, sudden asphyxiation, etc.)
* Administration of intramuscular, endotracheal tube, or intraosseous epinephrine
* Prisoners or persons in police custody
* Known allergy or sensitivity to epinephrine
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Unity Health Toronto

OTHER

Sponsor Role lead

Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

Pfizer

INDUSTRY

Sponsor Role collaborator

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Paul Dorian, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

Unity Health Toronto

Steve Lin, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

Unity Health Toronto

Locations

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British Columbia Emergency Health Services (BCEHS)

Victoria, British Columbia, Canada

Site Status RECRUITING

Peel Regional Paramedic Services

Brampton, Ontario, Canada

Site Status RECRUITING

Middlesex-London Paramedic Service

London, Ontario, Canada

Site Status RECRUITING

Halton Region Paramedic Services

Oakville, Ontario, Canada

Site Status RECRUITING

Ottawa Paramedic Services

Ottawa, Ontario, Canada

Site Status RECRUITING

Superior North Emergency Medical Services

Thunder Bay, Ontario, Canada

Site Status RECRUITING

Essex-Windsor Emergency Health Services

Windsor, Ontario, Canada

Site Status RECRUITING

Medavie Health Services West

Saskatoon, Saskatchewan, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Theresa Aves, MSc

Role: CONTACT

416-864-6060 ext. 46787

Facility Contacts

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Helen Connolly

Role: primary

604-806-8753

Theresa Aves

Role: primary

416-864-6060 ext. 46787

Manya Charette

Role: primary

613-798-5555 ext. 17758

Theresa Aves

Role: primary

416-864-6060 ext. 46787

Manya Charette

Role: primary

613-798-5555 ext. 17758

Manya Charette

Role: primary

613-798-5555 ext. 17758

Manya Charette

Role: primary

613-798-5555 ext. 17758

Tracy Wilson, PhD

Role: primary

306-655-2810

Other Identifiers

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EpiDOSE Protocol Version 3.0

Identifier Type: -

Identifier Source: org_study_id

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