Epi causing brain damage in cardiac arrest

[LACoGurneyjockey]

Just read an article in JEMS about a new study in the UK to test the effectiveness of Epi in cardiac arrest survival rates. Apparently they are planning to give 8000 prehospital cardiac arrests either the standard dose of Epinephrine or a saline placebo, unbeknownst to the patient, family, or medic administering.
Thoughts on the study?
And thoughts on the risk of brain damage in cardiac arrest survivors given Epi.
Anecdotally, of a very small number of cardiac arrests that we got ROSC, only one walked out of the hospital.
50 something male, witnessed arrest and bystander CPR, found in VF and shocked into sinus tach on our arrival, with a GCS of 15 by the time we put him into the ER bed. No drugs, no tube, and a 4 minute scene time.
So, is Epi really causing harm in cardiac arrests?

http://m.jems.com/article/news/medics-give-placebo-questionable-cardiac

 

[medicsb]

No one really knows if it causes harm. Sure, all the retrospective studies seem to show harm, but they're retrospective and not designed to show causality. There has only been one double-blind placebo-controlled trial and it did not show harm nor benefit despite epi trending better. It's about time a big study has been designed and implemented. I don't think this sort of study is ethically questionable. It IS ethically questionable to keep giving a med that has an unknown benefit and possible harm.

 

[Handsome Robb]

I fully support this study. As medicsb pointed out it has been studied but only one was a true double-blind placebo-controlled trial and it didn't really show a big difference either way.

I don't want to parrot what medicsb already said but I will give a +1 to this study not being ethically questionable and that giving a med "because we alway have" without studying it appropriately to determine if we truly are helping or actually causing harm. People keep using the argument that a cardiac arrest patient cannot consent to be in a trial since they're not alive, alert and oriented but with trials like this they make it public, have meetings and allow people to opt out. Most opt outs in trials such as this will be a bracelet/medic alert of some sort that is uniform for everyone and easily recognizable.

The other argument I've heard is "what if the medic grabs the placebo for an anaphylaxis patient?" Not a valid argument because steps are taken to avoid situations like this. They've been doing medical studies for a long time...it's not something new.