PANDA – Noradrenaline vs Adrenaline in the initial management of cardiogenic shock

An award-winning multi-centre, adaptive randomised controlled trial involving 890 participants, looking at 28-day all-cause mortality differences between using noradrenaline vs adrenaline in the pre-hospital management of patients experiencing cardiogenic shock.

Chief Investigators

Prof Dion Stub, Prof David Kaye, Prof Karen Smith, Prof Stephen Bernard

Funding source

Heart Foundation Vanguard Grant

Estimated completion date

June 2023

Background

Cardiogenic Shock is a common clinical problem encountered by ambulance paramedics, with over 1,500 cases treated in Victoria each year.  Morbidity and mortality (50%) remain unacceptably high at around 50% of patients. Upon admission to hospital, 34% require mechanical ventilation, 16% require cardiac catheterisation, and 6% require dialysis.

Ambulance services exclusively use adrenaline to correct hypoperfusion, however this has deleterious effects on cardiac tissue. The use of noradrenaline may be associated with less cardiac injury, and improve survival, however there are limited head-to-head comparisons between these that assess for major clinical outcomes. Retrospective comparisons have suggested patients treated with noradrenaline may experience less myocardial injury and trend to improved survival.

This grant application was awarded the 2021 Ross Honen award for research excellence by the National Heart Foundation.

Aim

Testing the safety and efficacy of adrenaline vs noradrenaline in patients with cardiogenic shock.

Outputs to date

Bloom JE, Nehme Z, Andrew E, Dawson LP, Fernando H, Noaman S, Stephenson M, Anderson D, Pellegrino V, Cox S, Lefkovits J, Chan W, Kaye DM, Smith K, Stub D. Hospital characteristics are associated with clinical outcomes in patients with cardiogenic shock. Shock. 2022 Sep 1;58(3):204-210. doi: 10.1097/SHK.0000000000001974. Epub 2022 Aug 26.

Bloom JE, Andrew E, Nehme Z, Beale A, Dawson LP, Shi WY, Vriesendorp PA, Fernando H, Noaman S, Cox S, Stephenson M, Anderson D, Chan W, Kaye DM, Smith K, Stub D. Gender Disparities in Cardiogenic Shock Treatment and Outcomes. Am J Cardiol. 2022 Aug 15;177:14-21. doi: 10.1016/j.amjcard.2022.04.047. Epub 2022 Jun 27.

Bloom JE, Andrew E, Dawson LP, Nehme Z, Stephenson M, Anderson D, Fernando H, Noaman S, Cox S, Milne C, Chan W, Kaye DM, Smith K, Stub D. Incidence and Outcomes of Nontraumatic Shock in Adults Using Emergency Medical Services in Victoria, Australia. JAMA Netw Open. 2022 Jan 4;5(1):e2145179. doi: 10.1001/jamanetworkopen.2021.45179.