Paramedic Randomized Trial of Noradrenaline Versus Adrenaline in the Initial Management of Patients with Cardiogenic Shock: The PANDA Trial

Cardiogenic shock is a critical, life-threatening condition where the heart is too weak to pump enough blood around the body — often following a heart attack. In this emergency setting, vasopressor medications are used to support blood pressure and maintain blood flow to vital organs. Two key drugs used for this are adrenaline (epinephrine) and noradrenaline (norepinephrine), but there is limited evidence on which one is more effective and safer. The PANDA Trial will be the first study to compare these two drugs when administered by paramedics in the pre-hospital setting — in the ambulance before hospital arrival — in patients experiencing cardiogenic shock. The trial aims to determine whether noradrenaline produces better clinical outcomes than adrenaline in this time-critical situation. You may be eligible if you are an adult aged 18 or older with signs of shock believed to be caused by a cardiac problem, and your systolic blood pressure is 90mmHg or below despite fluid treatment. People with shock from trauma, allergy, or asthma, those with a very slow heart rate, patients transferred from another facility, or those with cardiac arrest lasting over 30 minutes before resuscitation would not be eligible.