- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02387398
Early Coronary Angiography Versus Delayed Coronary Angiography (PEARL)
A Pilot Randomized Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography for Post-Cardiac Arrest Patients Without ECG ST Segment Elevation
Study Overview
Status
Intervention / Treatment
Detailed Description
Cardiac arrest is a major public health issue. Arizona has been a leader in improving long-term survival by introducing new and innovative resuscitation approaches including "Chest Compression-Only CPR" and "Cardiocerebral Resuscitation". Post-resuscitation care is the next great opportunity for further improvements. Early coronary angiography (CAG) combined with therapeutic hypothermia has become the recommended standard of care for post-cardiac arrest patients manifesting ST segment elevation on their electrocardiogram (ECG). However, the majority of cardiac arrest victims do not have ST segment elevation. There is clinical equipoise as to whether these patients will benefit from early CAG.
Subjects who are qualified for the study will be randomized 1:1 to one of two groups.
° Intervention Group-Early coronary angiography (door-to-angiography) within 120 minutes of admission to Emergency Department.
or
° Control Group-No early coronary angiography (within the first six hours from admission)
All enrolled patients, will be treated with therapeutic hypothermia which is standard of care, beginning simultaneously with both groups or within at least 2 hours of hospital arrival.
Subject will be followed for 180 days for safety and long-term survival.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Victoria
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Melbourne, Victoria, Australia, 3004
- Alfred Hospital
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-
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Ljubljana, Slovenia
- University Medical Center Ljubljana
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Arizona
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Tucson, Arizona, United States, 85724
- Banner University Medical Center-Tucson Campus
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Tucson, Arizona, United States, 85724
- Banner University Medical Center-South Campus
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Maine
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Portland, Maine, United States, 04103
- Tufts University School of Medicine, Maine Medical Center
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Minnesota
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Rochester, Minnesota, United States, 55905
- Mayo Clinic Cardiovascular Research Unit
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All successfully resuscitated out-of-hospital cardiac arrest patients with a suspected cardiac etiology for their non-traumatic arrest
- Age greater than 18 years
- The post resuscitation ECG shows no evidence of ST segment elevation
Exclusion Criteria:
- Non-resuscitated (no sustained pulse and BP)
- Presence ST segment elevation or new left bundle branch block present on the post-resuscitation ECG
- Suspected non-cardiac etiology for their arrest such as respiratory failure, asphyxia, pulmonary embolus, shock, trauma, drug overdose, or CNS bleed as likely cause of the cardiac arrest
- Known "Do Not Resuscitate" status
- Minors (<18 years old)
- Prisoners
- Significant bleeding or blunt trauma
- Known or confirmed pregnancy test by urinalysis
- Patients who are known to have received any other investigational therapies within the 30 days prior to enrollment or during study duration will be excluded unless these studies have been reviewed and approved by the Study Steering Committee.
- Known "opt out" choice; wearing Opt-out band for any EFIC approved study or on an "Opt-out" list
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Interventional
Early Angiography with purpose of coronary revascularization within 120 minutes of admission to ED, post out-of-hospital cardiac arrest, suspicious for cardiac etiology and no ST segment elevation on ECG
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Coronary Angiography within 120 minutes of admission for out-of-hospital cardiac arrest with ROSC
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No Intervention: Control Group
Standard of care treatment including therapeutic hypothermia in subjects post resuscitation, out-of-hospital cardiac arrest, suspicious for cardiac etiology and no ST segment elevation on ECG.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Safety and Efficacy of early coronary angiography in the out-of-hospital cardiac arrest (OHCA) patient population.
Time Frame: 180 days
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Safety will be assessed by evaluating any association of major adverse events (re-arrest, bleeding, pulmonary edema, hypotension, acute renal insufficiency, and pneumonia) with early coronary angiography.
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180 days
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Survival from hospital at: 30 days post discharge and 180 days post discharge
Time Frame: 30 days and 180 days
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Composite endpoint of improved left ventricular regional and global function (both regional wall motion analysis and left ventricular ejection fraction) as measured by echocardiography prior to hospital discharge, survival to discharge and favourable.
Left ventricular regional function and left ventricular ejection fraction as measured by echocardiography will be measured prior to discharge or up to 180 days post hospital discharge.
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30 days and 180 days
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Cognitive functional status
Time Frame: 180 days
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As measured by Modified Rankin Score (mRS) and Cerebral Performance Category (CPC) at multiple points up to 180 days post hospital discharge
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180 days
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Neurocognitive Testing
Time Frame: 180 days
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Neurocognitive function will be assessed at various time points utilizing a variety of tests from ICU discharge to 180 days post hospital discharge such as MMSE, MOCA, HADS, and IQCODE
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180 days
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Karl B Kern, MD, University of Arizona
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NCT02387398
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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