Poisoning
Conditions
Keywords
Renal Dialysis, Hemoperfusion, Paraquat
Brief summary
HeSAPP is a single-center, non-blinded, parallel-group randomized controlled trial studying the hemopurification strategy for acute paraquat(PQ) poisoned patients. The intervention to be investigated include hemodialysis (HD), hemoperfusion (HP), combined hemoperfusion-hemodialysis concurrent therapy (HP-HD) and conservative therapy. The object of the present trial is to investigate whether hemopurification therapy can reduce mortality compared with conservative therapy.
Detailed description
Patients diagnosed with acute paraquat poisoning in the Emergency Room of the First Affiliated Hospital of Zhengzhou University would be stratified according to their urine dithionite test results and randomly assigned to four different groups: HD, HP, HP-HD and control (conservative therapy) group for different treatment. Arterial blood gas test, complete blood count, coagulation function, liver function, pancreatic function, urine dithionite test, renal function and chest radiographs would be closely monitored during treatment. Primary endpoint is 28-day mortality. Secondary endpoints include (1) survival time (from the time of PQ ingestion to the time of death), all-cause mortality at the 3rd, 7th and 60th day; (2) rate of necessary oxygen uptake and rate of mechanical ventilation; (3) in-hospital length of stay and ICU length of stay; (4) APACHE II score and PSS score; (5) rate of general complications, such as respiratory failure, acute kidney injury (AKI), acute liver failure, pancreas function abnormality and Multiple Organ Failure (MOF); (6) rate of intervention related complications, such as catheter placement related complications, thrombocytopenia and deep venous thrombosis; (7) rate of adverse events, which include unexpected death, severe hemorrhage or edema, unplanned extubation, coagulation in the extracorporeal circulation, blockage of cartridge, incorrect pipe connection, etc.
Interventions
PROCEDUREHemodialysis
Participants in this group will be catheterize in the internal jugular vein and connect to a hemodialysis machine.
PROCEDUREHemoperfusion
Participants in this group will be catheterize in the internal jugular vein and connect to a hemoperfusion machine.
PROCEDUREHP-HD
Participants in this group will be catheterize in the internal jugular vein and connect to a hemoperfusion machine and then a hemodialysis machine for one course.
Sponsors
The First Affiliated Hospital of Zhengzhou University
National Natural Science Foundation of China
Peking Union Medical College Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
This study is designed as a non-blinded trial because of the apparently different equipment of the interventions
Intervention model description
Parallel Assignment
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Suspected paraquat ingestion history (intended or accidental), which is confirmed by positive urine dithionite result (light blue, navy blue and dark blue). * Arriving at the ER within 24 hours after PQ digestion. * No known current pregnancy or lactation. * Absence of cardiac arrest after poisoning, and no previous or present history of chronic kidney disease, chronic liver disease, respiratory failure, COPD, asthma, heart failure, pancreatic disease, acute coronary syndrome (ACS) or stoke. * No known combined ingestion with other poisons or alcohol. * No previous blood purification treatment prior to admission. * No known participation in other medical trials. * Agreement on informed consent.
Exclusion criteria
* Patients who are unable to comply with the procedures of the present trial, including those who change therapy or withdraw treatment. * Patients who develop severe allergic response to HP materials. * Patients who do not receive intervention within 4 hours after admission in reality.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 28-day all-cause mortality | From the day of intoxication to the 28th day afterwards. | Mortality=Dead patients/All patients in that group |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of multiple organ failure | From the day of intoxication to death or the 60th day. | Patients that develop multiple organ failure/All patients in that group |
| Rate of oxygen uptake | From the day of intoxication to death or the 60th day. | Patients that need oxygen therapy/All patients in that group |
| Rate of mechanical ventilation | From the day of intoxication to death or the 60th day. | Patients that need mechanical ventilation/All patients in that group |
| In-hospital length of stay | From the day of admission to discharge or up to 60 days after admission. | Day count from admission to discharge or the end of follow up. |
| Survival time | From the day of intoxication to death or the 60th day. | Live day count. |
| 7-day all-cause mortality | From the day of intoxication to the 7th day afterwards. | Mortality=Dead patients/All patients in that group |
| 60-day all-cause mortality | From the day of intoxication to the 60th day afterwards. | Mortality=Dead patients/All patients in that group |
| ICU length of stay | From the day of intoxication to death or the 60th day. | Day count spent in intensive care unit |
| Rate of catheter related complications | From the day of intoxication to death or the 60th day. | Complications due to catheterization, e.g. thrombocytopenia, deep venous thrombosis, catheter related infection. |
| 3-day all-cause mortality | From the day of intoxication to the 3rd day afterwards. | Mortality=Dead patients/All patients in that group |
Contacts
Primary ContactYi Li, M.D.
Backup ContactShiyuan Yu, M.D.
Outcome results
None listed