- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01186614
Refractory Out-Of-Hospital Cardiac Arrest Treated With Mechanical CPR, Hypothermia, ECMO and Early Reperfusion (CHEER)
Sudden out-of-hospital cardiac arrest (OHCA) is a leading cause of death in Australia. The most common cause of OHCA is a heart attack. The current treatment of OHCA is resuscitation by ambulance paramedics involving CPR, electrical shocks to the heart, and injections of adrenaline. In more than 50% of cases, paramedics are unable to start the heart and the patient is declared dead at the scene. Patients with OHCA who do not respond to paramedic resuscitation are not routinely transported to hospital because it is hazardous for paramedics to undertake rapid transport whilst administering chest compressions and there is currently no additional therapy available at the hospital that would assist in starting the heart.
However, a number of recent developments suggest that there may be a new approach to the resuscitation of this group of patients who would otherwise die.
Firstly, Ambulance Victoria have recently introduced portable battery powered machines that allow chest compressions to be safely and effectively delivered during emergency ambulance transport.
Second, The Alfred ICU will shortly be implementing a new protocol whereby the patient in cardiac arrest can immediately be placed on a heart-lung machine. This is known as extra-corporeal membrane oxygenation (ECMO).
Third, the brain can now be much better protected against damage due to lack of blood flow using therapeutic hypothermia which is the controlled lowering of body temperature from 37°C to 33°C. Clinical trials have demonstrated that this significantly decreases brain damage after OHCA.
Finally, The Alfred Cardiology service has an emergency service for reopening the blocked artery of the heart in patients who present with a sudden blockage of the heart arteries. This is currently not used in patients without a heart beat because of the technical difficulty of undertaking this procedure with chest compressions being undertaken.
This study proposes for the first time to implement all the above interventions when patients have failed standard resuscitation after OHCA. When standard resuscitation has proved futile, the patient will be transported to The Alfred with the mechanical chest compression device, cooled to 33°C, placed on ECMO, and then transported to the interventional cardiac catheter laboratory. The patient will then receive therapeutic hypothermia for 24 hours. Subsequent management will follow the standard treatment guidelines of The Alfred Intensive Care Unit.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Anticipated)
Phase
- Phase 1
Contacts and Locations
Study Contact
- Name: Stephen A bernard, MBBS MD
- Phone Number: 9076200
- Email: s.bernard@alfred.org.au
Study Contact Backup
- Name: Dion A Stub, MBBS
- Phone Number: 90762000
- Email: d.stub@alfred.org.au
Study Locations
-
-
Victoria
-
Melbourne, Victoria, Australia, 3161
- Recruiting
- Alfred Hospital
-
Contact:
- Stephen Bernard, MBBS MD
- Phone Number: 90762000
-
Principal Investigator:
- Stephen A Bernard, MBBS MD
-
Sub-Investigator:
- Dion A Stub, MBBS
-
Sub-Investigator:
- Vincent Pellegrino, MBBS
-
Sub-Investigator:
- Lisen Hockings, MBBS
-
Sub-Investigator:
- Matthew Reid, RN
-
Sub-Investigator:
- David M Kaye, MBBS PhD
-
Sub-Investigator:
- Stephen J Duffy, MBBS PhD
-
Sub-Investigator:
- Peter Cameron, MBBS MD
-
Sub-Investigator:
- De Villiers Smit, MBBS
-
Melbourne, Victoria, Australia
- Not yet recruiting
- Ambulance Victoria
-
Contact:
- Karen Smith, BSc PhD
- Phone Number: 9840 3752
- Email: karen.smith@ambulance.vic.gov.au
-
Sub-Investigator:
- Karen Smith, BSc PhD
-
Sub-Investigator:
- Tony Walker, HlthSci MICA
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adults 18-59 years
- Out of hospital cardiac arrest due to presumed cardiac caus
- Chest compressions are commenced within 10 minutes by bystanders or emergency medical services
- Initial cardiac arrest rhythm of ventricular fibrillation
- Remains in cardiac arrest at the scene at 20 minutes after standard paramedic advanced cardiac life support (intubation, intravenous adrenaline)
- Autopulse machine is available
- Within 10 minutes ambulance transport time to The Alfred
- During normal working hours (9am-5pm, Monday to Friday)
- ECMO commences within 60 minutes of the initial collapse
Exclusion Criteria:
- Presumed non-cardiac cause of cardiac arrest such as trauma, hanging, drowning, intracranial bleeding
- Any pre-existing significant neurological disability
- Significant non-cardiac co-morbidities that cause limitations in activities of daily living such as COPD, cirrhosis of the liver, renal failure on dialysis, terminal illness due to malignancy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Novel treatment paradigm
treatment protocol including - mechanical CPR, therapeutic hypothermia, ECMO, coronary intervention
|
Automated CPR utilised by paramedics to facilitate CPR during transport to hospital
Other Names:
Insertion of peripheral VA ECMO
Coronary angiography and intervention where necessary will be performed following ECMO insertion
Paramedic initiated hypothermia with intravenous ice cold fluid and then continued for 24 hours (33 degrees)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Survival to hospital discharge
Time Frame: At hospital discharge
|
At hospital discharge
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Neurologic recovery
Time Frame: At discharge
|
Assessed by cerebral performance category
|
At discharge
|
Time until ECMO insertion
Time Frame: On admission
|
On admission
|
|
neurologic biomarkers
Time Frame: Day 3
|
neuron-specific enolase and S100β
|
Day 3
|
Cardiac recovery
Time Frame: Days 1, 3, 5
|
measured by echocardiography and cardiac biomakers including troponin, CK and BNP
|
Days 1, 3, 5
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Stephen A Bernard, MBBS MD, The Alfred
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- project 160/10
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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