Placebo drug for cardiac arrest patients in Shropshire trial
Patients in Shropshire whose hearts stop could be given a placebo instead of adrenaline during a study into whether or not the current treatment saves lives.
Paramedics at the West Midlands and Welsh Ambulance Services will give people in cardiac arrest either salt water or adrenaline in a trial due to start in the autumn.
Neither the medic, nor the patient or their relatives will know which they are getting. Current guidelines used by the ambulance services recommend routinely giving adrenaline during the resuscitation of patients who have suffered cardiac arrest.
But there are concerns that adrenaline may cause brain damage and may not help overall survival at all.
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A new study, led by Warwick University, will be rolled out across Shropshire and Wales as well as London, the South coast and the North East.
The first 8,000 patients who suffer a cardiac arrest in these areas will be included.
People will, in theory, be able opt out of the study in advance.
But Dr Martin Underwood, whose team at Warwick University is running the study, acknowledged that few were likely to opt out and that the logistics of checking the identity and wishes of patients during frantic attempts to save their lives would be difficult.
He stressed that other resuscitation including heart massage and defibrillation would be conducted as normal.
"We do not know that adrenaline does improve survival," he said. "It is possible that it improves short-term survival but few patients leave hospital and it may be at the cost of neurological damage.
"There are sufficient grounds for concern that what we are doing at the moment is detrimental to people."
West Midlands Ambulance Service medical director Dr Andy Carson said: "Although adrenaline has been used for many years in cardiac arrest management, there is growing evidence that it may result in poorer outcomes for patients, hence the need for a trial.
"We know that a number of survivors of cardiac arrest suffer from brain damage due to a lack of oxygen. Developments in brain imaging are now suggesting that the use of adrenaline, while helping to restart the heart, may cause more harm than good."
Professor Gavin Perkins, of the University of Warwick, said: "The need to do this research is underpinned by a serious concern that although using adrenaline might help restart the heart in the short term, it causes severe brain damage leading to death a few hours or days later.
"We want the best possible outcomes for all people who have a cardiac arrest, both now and in the future.
"All patients will receive the treatment that is proven to improve survival from cardiac arrest, CPR and defibrillation."
Dr Underwood said the data would be reviewed at regular intervals and if it was clear that the dummy group or the adrenaline group was doing better than the study would be stopped.
He said: "We wouldn't expect people would be put at unnecessary risk by this."
There are thought to be about 50,000 people in Britain who suffer a cardiac arrest outside of hospitals, with just six per cent surviving and fewer still having no lasting brain damage.
Adrenaline has been used in resuscitation since the 1960s, before randomised controlled trials were conducted, Dr Underwood said.
The study, titled Paramedic 2: the adrenaline trial, is being supported by the Resuscitation Council.
There have also been calls for urgent studies into the use of adrenaline by the International Liaison Committee for Resuscitation.
Star comment: Dangers of placebo experiment