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

Shock is a clinical syndrome which is characterised by cellular and tissue hypoxia due to either inadequate oxygen delivery, increased oxygen demand, or a combination of these processes. It may present on a clinical spectrum ranging from occult hypoperfusion (with preserved blood pressure) to fulminant circulatory collapse. Prompt haemodynamic support of patients with shock is vital to prevent and potentially reverse multi-organ dysfunction. In addition to treating the underlying disease process, intravenous fluid administration constitutes an essential part of the initial management. However, often fluid resuscitation is insufficient and hypotension persists. In this clinical setting vasopressor and/or inotropic medications can be considered. The efficacy of these drugs has largely been assessed though their impact on haemodynamic end-points. Head-to-head comparison between these agents assessing for major clinical outcomes, such as mortality, is limited. However, in small studies of cardiogenic shock, noradrenaline appears to be superior to adrenaline. We aim to compare the efficacy of noradrenaline and adrenaline in the pre-hospital setting in a population experiencing cardiogenic shock