Prehospital epinephrine, vasopressin, and steroid for out-of-hospital cardiac arrest

A Randomized Clinical Trial of Patient Outcomes Following Out-of-Hospital Cardiac Arrest Receiving Epinephrine Versus In-together Vasopressin, Epinephrine, and Steroid. (OHCA REVIVES Trial)

This trial tests whether giving epinephrine together with vasopressin and a steroid in the ambulance helps adults with non‑traumatic out‑of‑hospital cardiac arrest in Taipei and New Taipei City achieve sustained return of spontaneous circulation.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 1344 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: National Taiwan University Hospital (Academic / other)
• Locations: 1 site (Taipei)
• Trial ID: NCT06203847 on ClinicalTrials.gov

What this trial studies

This is a randomized prehospital clinical trial comparing standard epinephrine alone to a combination of epinephrine, vasopressin, and methylprednisolone administered by trained paramedics. The combination arm uses standard epinephrine doses with 20 U vasopressin after each epinephrine dose (up to 80 U) and a single 40 mg dose of methylprednisolone after the first epinephrine. The primary outcome is sustained return of spontaneous circulation (ROSC) and secondary outcomes include longer-term survival. The trial plans to enroll about 1,344 adult non‑traumatic OHCA patients treated by EMS in Taipei City and New Taipei City.

Who should consider this trial

Good fit: Adults aged 18 or older who suffer non‑traumatic out‑of‑hospital cardiac arrest within the Taipei City or New Taipei City EMS systems and are resuscitated by trial‑trained paramedics with vascular access established are the intended participants.

Not a fit: Patients with traumatic cardiac arrest, obvious signs of death, DNR orders, known or suspected pregnancy, ROSC before medication, no vascular access, or who received epinephrine before trial paramedics arrive are unlikely to be eligible or receive benefit from the intervention.

Why it matters

Potential benefit: If successful, the combination treatment could increase rates of sustained ROSC and improve longer-term survival after out‑of‑hospital cardiac arrest.

How similar studies have performed: Previous randomized work combining vasopressin, steroids, and epinephrine showed promising results in some in‑hospital cardiac arrest populations, but evidence for prehospital OHCA is limited and results have been mixed.

Eligibility criteria

Inclusion Criteria:

* Adult patients (aged \>= 18 )
* Out-of-hospital cardiac arrest in the studied regions
* Treated by paramedics authorized and capable of giving prehospital medication

Exclusion Criteria:

* OHCA with traumatic etiology
* Obvious signs of death like decapitation, rigor mortis, livor mortis, decomposition, etc.
* DNR (Do Not Resuscitation) or termination of resuscitation requested by the family
* Patients with known or suspected pregnancy
* No vascular access was established before hospital arrival
* ROSC before the administrated medication
* No patient contact (cancelled ambulance call or the patient was transported to the hospital before the arrival of trial-trained paramedics)
* Received epinephrine prior to the arrival of trial-trained paramedics

Where this trial is running

Taipei

• National Taiwan University Hospital — Taipei, Taiwan (Recruiting)

Study contacts

• Principal investigator: WEN CHU CHIANG, Phd — National Taiwan University Hospital
• Study coordinator: WEN CHU CHIANG, PhD

Conditions Cardiac Arrest; Out-Of-Hospital Cardiac Arrest; Emergency Medical Services; Corticosteroid; Epinephrine; Vasopressin