What is the clinical evidence from this study?

Study design: RCT. Population: Out-of-hospital cardiac arrest (OHCA) (n=476). Intervention: Erythropoietin (epoetin alfa) vs. Standard care without Epo. Primary outcome: Proportion of patients reaching level 1 on the Cerebral Performance Category (CPC) scale (survival with no or minor neurological sequelae) at day 60 (OR 1.01, 95% CI 0.68 to 1.48).

What does this research mean for the field?

Early administration of high-dose erythropoietin after out-of-hospital cardiac arrest does not improve survival with good neurological outcomes and is associated with increased thrombotic complications. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the efficacy and safety of high-dose epoetin alfa on neurological recovery and survival in comatose patients resuscitated from out-of-hospital cardiac arrest.

September 16, 2026Journal of the American College of CardiologyOpen Access

Early High-Dose Erythropoietin Therapy After Out-of-Hospital Cardiac Arrest

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Key result

Early high-dose erythropoietin shows no benefit over standard care for 60-day neurologically intact survival.

OR 1.01
95% CI 0.68 to 1.48
n=476

Authors

ACAlain CariouInserm NDNicolas DeyeInserm BVBenoît VivienHôpital Necker-Enfants Malades

Discussion

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Implication

Randomized trial reveals no neurological benefit and increased complications with high-dose erythropoietin after cardiac arrest, indicating routine administration is not warranted.

Key Points

To evaluate the efficacy and safety of high-dose epoetin alfa on neurological recovery and survival in comatose patients resuscitated from out-of-hospital cardiac arrest.
Multicenter, single-blind, randomized controlled trial (N=476; NCT00999583) enrolling comatose patients after witnessed out-of-hospital cardiac arrest of presumed cardiac origin.
Patients received standard care alone or standard care plus 5 intravenous injections of epoetin alfa (40,000 units every 12 hours up to 200,000 total units) initiated promptly after resuscitation, with follow-up at day 60.
At day 60, 32.4% (76/234) of patients receiving epoetin alfa reached Cerebral Performance Category level 1 compared with 32.1% (78/242) of control patients (OR: 1.01; 95% CI: 0.68 to 1.48).
Erythropoietin therapy was associated with significantly higher rates of serious adverse events (22.6% vs. 14.9%; p = 0.03) and thrombotic complications (12.4% vs. 5.8%; p = 0.01) compared with control.

Study Design

Type

RCT (n=476)

Blinding

Single-blind

Randomization

randomized

Multicenter

Yes

PICO

Population

476 comatose patients after a witnessed out-of-hospital cardiac arrest of presumed cardiac origin, followed for 60 days.

Intervention / Comparator

Erythropoietin (epoetin alfa) vs Standard care without Epo (5 intravenous injections spaced 12 h apart during the first 48 h (40,000 units each, maximal dose of 200,000 total units))

Primary Outcome

Proportion of patients reaching level 1 on the Cerebral Performance Category (CPC) scale (survival with no or minor neurological sequelae) at day 60 — OR 1.01 (0.68 to 1.48)

Main Result

Odds Ratio: 1.01 (95% CI 0.68–1.48)

Absolute Event Rate: 32.4% vs 32.1%

Cite This Study

Cariou et al. (2016) conducted an RCT in Out-of-hospital cardiac arrest (OHCA) (n=476). Erythropoietin (epoetin alfa) vs. Standard care without Epo was evaluated on Proportion of patients reaching level 1 on the Cerebral Performance Category (CPC) scale (survival with no or minor neurological sequelae) at day 60 (OR 1.01, 95% CI 0.68 to 1.48). Early high-dose erythropoietin therapy did not improve survival with no or minor neurological sequelae at 60 days compared to standard care (32.4% vs 32.1%; OR 1.01; 95% CI 0.68-1.48).

synapsesocial.com/papers/6aaa5e55c0c5ec5c126fa6f7 https://doi.org/10.1016/j.jacc.2016.04.040

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Implication

Randomized trial reveals no neurological benefit and increased complications with high-dose erythropoietin after cardiac arrest, indicating routine administration is not warranted.

Early High-Dose Erythropoietin Therapy After Out-of-Hospital Cardiac Arrest

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Main Result

Cite This Study

Early High-Dose Erythropoietin Therapy After Out-of-Hospital Cardiac Arrest

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Main Result

Cite This Study

Also Consider

Also Consider