Epinephrine Dose: Optimal Versus Standard Evaluation Trial (EpiDOSE)

September 28, 2026 updated by: Unity Health Toronto

CanROC Epinephrine Dose: Optimal Versus Standard Evaluation Trial (CanROC EpiDOSE Trial)

The objective of this randomized controlled trial is to evaluate whether a low cumulative dose of epinephrine ("low dose") is non-inferior to a standard cumulative dose of epinephrine ("standard dose") with respect to survival to hospital discharge among adults undergoing resuscitation for OHCA due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

This study is designed as a prospective, multicentre, single-blinded randomized controlled trial (RCT) where eligible OHCA patients are randomized to receive a low cumulative dose of epinephrine (low dose epinephrine, up to 2mg total) or a standard cumulative dose of epinephrine (standard dose epinephrine, up to 6mg total) in a 1:1 fashion.

Eligible OHCA patients will be treated by paramedics who will initiate cardiopulmonary resuscitation (CPR) and the delivery of defibrillation shocks per paramedic agencies' treatment protocols. After one defibrillation and when feasible, paramedics will establish peripheral intravenous (IV) access, and patients will be randomly allocated to either the low dose or standard dose treatment arm. Epinephrine doses (according to treatment assignment) will be administered every 3-5 minutes, based on current guidelines and paramedic protocols, until the first return of spontaneous circulation (ROSC) is achieved or if resuscitation has been terminated by the base hospital physician. Other medications (e.g. antiarrhythmics, magnesium, beta blockers) and interventions (e.g. intubation) may be interposed as required. Follow-up will take place using a combination of administrative databases (e.g. the Discharge Abstract Database and the National Ambulatory Care Reporting System) and telephone interviews.

This RCT will evaluate a fundamental change in the treatment of OHCA. The investigators hypothesize that a low cumulative dose of epinephrine will improve patient survival to hospital discharge compared to a standard cumulative dose of epinephrine. Please feel free to contact epidose@unityhealth.to for further information.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
1250

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • Canada
    • British Columbia
      • Victoria, British Columbia, Canada, V8W 9P1
        • Recruiting
        • British Columbia Emergency Health Services (BCEHS)
        • Principal Investigator:
          • Brian Grunau, MD
        • Contact:
    • Ontario
      • Brampton, Ontario, Canada, L6T 4B9
        • Recruiting
        • Peel Regional Paramedic Services
        • Principal Investigator:
          • Sheldon Cheskes, MD
        • Contact:
      • London, Ontario, Canada, N6E 1R4
        • Recruiting
        • Middlesex-London Paramedic Service
        • Principal Investigator:
          • Christian Vaillancourt, MD
        • Contact:
        • Sub-Investigator:
          • Matthew Davis, MD
      • Oakville, Ontario, Canada, L6M 3L1
        • Recruiting
        • Halton Region Paramedic Services
        • Principal Investigator:
          • Sheldon Cheskes, MD
        • Contact:
      • Ottawa, Ontario, Canada, K1H 1E2
        • Recruiting
        • Ottawa Paramedic Services
        • Principal Investigator:
          • Christian Vaillancourt, MD
        • Contact:
      • Thunder Bay, Ontario, Canada, P7B 4X6
        • Recruiting
        • Superior North Emergency Medical Services
        • Principal Investigator:
          • Christian Vaillancourt, MD
        • Contact:
        • Sub-Investigator:
          • David Savage, MD
      • Waterloo, Ontario, Canada, N2G 4J3
        • Recruiting
        • Region of Waterloo Paramedic Services
        • Contact:
        • Principal Investigator:
          • Paul Miller, MD
      • Windsor, Ontario, Canada, N9A 1N6
        • Recruiting
        • Essex-Windsor Emergency Health Services
        • Principal Investigator:
          • Christian Vaillancourt, MD
        • Contact:
    • Saskatchewan
      • Saskatoon, Saskatchewan, Canada, S7J 4M2
        • Recruiting
        • Medavie Health Services West
        • Contact:
        • Principal Investigator:
          • Andrew Leach, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Out-of-hospital cardiac arrest treated by paramedics AND
  • Initial recorded cardiac rhythm of VF or pulseless VT, or, AED shock on first analysis administered or confirmed by paramedics or fire services, AND
  • Established intravenous vascular access

Exclusion Criteria:

  • Known or apparent age <18 years
  • Initial recorded cardiac rhythm of VF or pulseless VT, or, AED shock on first analysis administered or confirmed by paramedics
  • Cardiac arrest due to an obvious non-cardiac primary cause (e.g. blunt or penetrating trauma, exsanguination, burns, drug overdose, drowning, anaphylaxis, sudden asphyxiation, etc.)
  • Administration of intramuscular, endotracheal tube, or intraosseous epinephrine
  • Prisoners or persons in police custody
  • Known allergy or sensitivity to epinephrine

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Active Comparator: Low Dose Epinephrine

Epinephrine up to 2mg total
Drug: Epinephrine

Epinephrine 1mg 1:10000 (10cc) per dose

Other Names:
  • Adrenaline
Active Comparator: Standard Dose Epinephrine

Epinephrine up to 6mg total
Drug: Epinephrine

Epinephrine 1mg 1:10000 (10cc) per dose

Other Names:
  • Adrenaline

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Survival to hospital discharge
Time Frame: Through study completion (up to 5 years)

Individuals discharged alive from hospital
Through study completion (up to 5 years)

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Return of spontaneous circulation in out-of-hospital setting
Time Frame: Through study completion (up to 5 years)

Return of spontaneous circulation in the field
Through study completion (up to 5 years)
Survival to emergency department arrival
Time Frame: Through study completion (up to 5 years)

Individuals alive upon arrival to a hospital emergency department
Through study completion (up to 5 years)
Survival to admission with death prior to discharge
Time Frame: Through study completion (up to 5 years)

Individuals alive upon hospital admission who die in-hospital before being discharged
Through study completion (up to 5 years)
Survival to discharge outside of a long-term healthcare facility e.g. nursing home
Time Frame: Through study completion (up to 5 years)

Individuals discharged alive from hospital to a care facility
Through study completion (up to 5 years)
Modified Rankin Scale (mRS) score
Time Frame: 12+/-3 months

Assessment of neurological function, scores range from 0 to 6 where higher scores indicate worse neurological function (0=no symptoms, 6=dead)
12+/-3 months
Health Utility Index-3 (HUI-3) score
Time Frame: 12+/-3 months

Assessment of quality of life, scores range from -0.36 to 1 where higher scores indicate better quality life (negative scores=a state worse than being dead, 0=dead, 1=perfect health)
12+/-3 months
Hospital Anxiety and Depression Scale score
Time Frame: 12+/-3 months

Assessment of quality of life, scores range from 0 to 21 where higher scores indicate more anxiety/depression
12+/-3 months
Length of stay in hospital
Time Frame: Through study completion (up to 5 years)

Length of time an individual remained in-hospital (length in days)
Through study completion (up to 5 years)
Length of stay in critical care unit
Time Frame: Through study completion (up to 5 years)

Length of time an individual remained in a crucial care unit (length in days)
Through study completion (up to 5 years)
Survival post-arrest
Time Frame: Up to 5 years

Survival following hospital discharge, up to 5 years
Up to 5 years
Recurrent cardiac arrest(s)
Time Frame: Up to 5 years

Number of cardiac arrests following the index arrest
Up to 5 years
ICD implant post-arrest
Time Frame: Up to 5 years

Whether an implantable cardioverter defibrillator was implanted post-arrest
Up to 5 years
Cardiovascular re-hospitalization(s)
Time Frame: Up to 5 years

Number of cardiovascular re-hospitalizations
Up to 5 years
All-cause re-hospitalizations(s)
Time Frame: Up to 5 years

Number of re-hospitalizations for any reason
Up to 5 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Unity Health Toronto

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Canadian Institutes of Health Research (CIHR)

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Paul Dorian, MD, MSc, Unity Health Toronto
  • Principal Investigator: Steve Lin, MD, MSc, Unity Health Toronto

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
May 24, 2023

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 1, 2028

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 1, 2028

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
November 7, 2018

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
January 30, 2019

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
February 1, 2019

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
October 2, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 28, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
December 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • EpiDOSE Protocol Version 4.0

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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