Project Details

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

Janice Tijssen, MD, MSc

Summary

BACKGROUND: Paediatric out-of-hospital cardiac arrest (POHCA) is rare and has a survival rate of less than 10% where every minute in delay of epinephrine results in 9% drop in survival. In a local urban sample, 84% of events had a first epinephrine dose administration after 5 minutes of arrival of paramedics and 29% after 10 minutes. GAP: Epinephrine for cardiac arrest is not within the scope of practice of Primary Care Paramedics (PCP), who attend majority of non-urban cardiac arrests and are usually 1st on scene, and therefore no epinephrine is administered at these events. Furthermore, for advanced care paramedics, epinephrine is often delayed because the intravenous (IV) or intraosseous (IO) routes can be challenging to establish in a child with POHCA. HYPOTHESIS: IM (intra-muscular) epinephrine will be a more efficient method for administering the initial, potentially lifesaving, epinephrine dose to a child experiencing POHCA with no greater risk of harm relative to the standard of care. METHODS: The PRIME-1 Trial is a pragmatic, two-arm, open-label, prospective stepped-wedge cluster quasi-randomized control trial (SW-CRCT). Paramedic agencies will start in the control arm (standard of care) and then will be randomized into the intervention arm for the duration of the study period. The intervention arm will add immediate IM epinephrine at 0.3, 0.5, 1, 2 or 3mg doses, depending on patient weight. RESULTS: Pending. IMPACT: We hope to show that epinephrine administered more quickly via the IM route will improve patient outcomes. This could result in a change in how we manage POHCA in the pre-hospital setting. If IM epinephrine is effective, then all children could receive earlier epinephrine, including twice as many children with OHCA who wouldn’t have received epinephrine on scene otherwise. Website Link: Please see link to our PRIME trial training video.