Cardiac Arrest, Out-Of-Hospital Cardiac Arrest, Emergency Medical Services
Conditions
Keywords
Out-Of-Hospital Cardiac Arrest, Emergency Medical Services, Corticosteroid, Epinephrine, Vasopressin
Brief summary
This project is a randomized controlled clinical research design, The hypothesis P-I-C-O of the study is: For adult patients in the Taipei City and New Taipei City communities who have suffered sudden non-traumatic death and have been resuscitated by advanced paramedics, the intervention group that receives combined drug treatment (epinephrine, vasopressin, methylprednisolone) has a better rate of sustained recovery of spontaneous circulation (ROSC) (primary outcome) and long-term survival status (secondary outcomes) compared to the control group that receives single drug treatment (epinephrine).
Detailed description
The global and Taiwanese survival rates for patients following an out-of-hospital cardiac arrest (OHCA) are less than 10%. The emergency medical system (EMS) plays a crucial role in patient outcomes after OHCA, providing prehospital cardiopulmonary resuscitation, defibrillation, and medication. Among these medications, the combination of epinephrine, vasopressin, and methylprednisolone holds the most potential to improve patient survival rates following OHCA. This study aims to compare the effect of standard epinephrine therapy with a combination of epinephrine, vasopressin, and methylprednisolone administered to OHCA patients. This comparison will be made through a randomized clinical trial (RCT) within the EMS of Taipei City and New Taipei City. Throughout the research plan, we will conduct a prehospital RCT to answer the following question (in P-I-C-O format): Will adult non-traumatic OHCA patients resuscitated by paramedics in a prehospital setting have a better chance of sustained recovery of spontaneous circulation (primary outcome), and improved survival status (secondary outcomes), if they receive combination therapy (i.e., standard doses of epinephrine, 20U of vasopressin after each dose of epinephrine up to a maximum of 80U, and one dose of 40mg methylprednisolone after the first dose of epinephrine) compared to those who receive standard doses of epinephrine? We estimate a sample size of 1,344 OHCA patients to detect a difference in the primary outcome. Based on the background data from the EMS regions under study, we expect the enrollment to take approximately 30 months to complete. This study is referred to as the OHCA-REVIVES trial, which stands for A randomized clinical trial of patient outcomes following Out-of-Hospital Cardiac Arrest Receiving Epinephrine Versus In-together Vasopressin, Epinephrine, and Steroid. The anticipated results from the OHCA-REVIVES trial will help determine the optimal strategy for prehospital medication, and will undoubtedly have a significant impact on resuscitation science. Through these efforts, we aim to improve the outcomes of OHCA patients.
Interventions
Combination of epinephrine (Adrenaline® 1mg/vial) every 3-5 minutes, vasopressin (Pitressin® 20Unints/vial) every 3-5 minutes up to 4 vials (a total of 80Units), methylprednisolone (Solu-Medrol® 40mg/vial)
DRUGStandard group
standard doses of epinephrine (Adrenaline® 1mg/vial) every 3-5 minutes
Sponsors
National Taiwan University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Participant: adult patients with OHCA Outcomes Assessor: in-hospital care providers (physicians, nurses...etc)
Intervention model description
a pragmatic randomized clinical trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients (aged \>= 18 ) * Out-of-hospital cardiac arrest in the studied regions * Treated by paramedics authorized and capable of giving prehospital medication
Exclusion criteria
* OHCA with traumatic etiology * Obvious signs of death like decapitation, rigor mortis, livor mortis, decomposition, etc. * DNR (Do Not Resuscitation) or termination of resuscitation requested by the family * Patients with known or suspected pregnancy * No vascular access was established before hospital arrival * ROSC before the administrated medication * No patient contact (cancelled ambulance call or the patient was transported to the hospital before the arrival of trial-trained paramedics) * Received epinephrine prior to the arrival of trial-trained paramedics
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of sustained return of spontaneous circulation (ROSC) | estimated 2 hours | Return of spontaneous circulation (ROSC) is the restart of a sustained heart rhythm measured by pulsation and vital signs that permeate the body after a cardiac arrest. Sustained ROSC ≥ 2 hours has been used as an surrogate to survival to hospital admission in many overcrowded emergency departments (ED). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of prehospital return of spontaneous circulation (ROSC) | estimated 1 hour | presence of ROSC prior to arrival at emergency department (ED) |
| Rate of survival to hospital discharge | estimated 30 days | survival to hospital admission, and without in-hospital death |
| Rate of survival with favorable neurologic status | estimated 30 days | Good neurologic status (defined as Cerebral-Performance Category (CPC) score 1 and 2) at hospital discharge |
Countries
Taiwan
Contacts
Primary ContactWEN CHU CHIANG, PhD
Outcome results
None listed