Epinephrine Dose: Optimal versus Standard Evaluation (EpiDOSE) Trial
PI: Paul Dorian
Co-PI: Steve Lin
Summary: The current standard dose of intravenous (IV) epinephrine for out-of-hospital cardiac arrest (OHCA) resuscitation is 1mg every 3-5 minutes; however, there is a lack of evidence for epinephrine use and its current standard dosing. There has been limited randomized controlled trial (RCT) evidence showing improved long term survival with epinephrine. Only one RCT was able to demonstrate the benefit of epinephrine (compared to placebo) on long-term survival however they were unable to show any difference in neurological function.
The objective of the EpiDOSE trial is to evaluate the effectiveness of a low cumulative dose of epinephrine (“low dose”) compared tothe current standard cumulative dose of epinephrine (“standard dose”) during resuscitation of adult OHCA patients with VF/VT. Patients will be given cardiopulmonary resuscitation (CPR) as per resuscitation guidelines. After an IV line is established patients will receive either: 1) Epinephrine 1mg IV boluses for up to 8 doses (standard dose)or 2) Epinephrine 1mg IV boluses for up to 2 doses and all 6 subsequent boluses will be placebo(low dose). The primary outcome for this trial is patient survival to hospital discharge. A total sample size of 3790 patients (1895 per arm) is anticipated over an enrollment period of 4 years.