Letter to the Editor
Regarding the review by Rory Spiegel, MD, of the PARAMEDIC2 trial, I would like to offer another interpretation of the study. (“No Benefit of Epinephrine in OHCA,” EMN 2018;40:1; http://bit.ly/2NfBWWs.)
The study shows that epinephrine in OHCA will likely not improve neuro-intact survival if your EMS agency does not give the drug earlier than a median of 14.8 minutes after arrival and if your EMS agency has a very low overall survival rate for OHCA, one-fifth that of the great state of Oregon, according to 2017 CARES data. (Resuscitation 2017;120:5; http://bit.ly/2K2H3cs.)
Repeating this study in the United States with EMS agencies with a CPR fraction greater than 90 percent and who give epi early (less than 10 minutes after EMS arrival) would help better define the utility of this drug in OHCA.
William J. Reed, MD