Respiration and Applied Tension Strategies to Reduce Vasovagal Reactions to Blood Donation

For a number of years, researchers have examined the effects of the muscle-tensing technique, Applied Tension (AT), on blood donation-related vasovagal symptoms and donor retention. AT was developed originally to reduce symptoms and avoidance behaviour in people with strong fears of blood and needles (phobics). It was based on the idea that exercise-related increases in blood pressure might be able to counteract the effects of stimuli that lead to a decrease in delivery of blood to the brain. AT was adapted for non-phobic blood donors and significant reductions in self-reported vasovagal symptoms and the need for nurse-initiated treatment as well as increases in donor retention were observed in some groups.

That said, individual response to AT is quite variable. This is probably related to recent research indicating that exercise-related maintenance of heart rate and blood pressure plays only a minor role in reducing vasovagal symptoms. Rather, AT appears to be working at least in part by regulating breathing and reducing the possibility of hyperventilation. Pilot results suggest that a novel intervention aimed specifically at breathing may be more effective and reliable than traditional AT. To evaluate this idea, 408 blood donors at mobile clinics in colleges and universities will be assigned randomly to four conditions. In brief, 5-minute preparation sessions using a notebook computer, donors will either learn a respiration control technique to avoid hyperventilation, AT, both, or neither. As a manipulation check and also a means of examining mechanisms of the interventions, e.g., the possibility that AT may work by regulating breathing and CO2, participants will wear non-invasive portable capnometers while they are giving blood. Outcome will also be assessed by self-report of vasovagal symptoms, observational data, and number of return visits to a blood clinic in the following year verified by the provincial blood collection agency, Héma-Québec. As a secondary aim, the research will examine possible moderating effects of pre-donation anxiety and sex.

The development of simple, effective approaches to reduce vasovagal symptoms during blood donation has the potential to improve the blood donation experience and blood donor retention as well as encourage people who have never given blood to consider the procedure. It will also improve medical and dental care more generally given the use of needles in so many procedures.

Study Overview

• Status: Unknown
• Conditions: Syncope, Vasovagal
• Intervention / Treatment: Behavioral: Applied Tension; Behavioral: Respiration Control; Behavioral: Applied Tension/Respiration Control

Detailed Description

See above.

• Study Type: Interventional
• Enrollment (Anticipated): 408
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Blaine Ditto, PhD; Phone Number: 514-398-6097; Email: blaine.ditto@mcgill.ca

Study Locations

• Canada
  • Quebec
    • Montréal, Quebec, Canada, H3A1B1
      • Recruiting
      • McGill University
      • Contact: Blaine Ditto, PhD; Phone Number: 514-398-6097; Email: blaine.ditto@mcgill.ca

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 39 years (ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Healthy volunteer blood donors.

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: BASIC_SCIENCE
• Allocation: RANDOMIZED
• Interventional Model: FACTORIAL
• Masking: NONE

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
NO_INTERVENTION: Blood Donation As Usual; Volunteer blood donors complete assessment materials, including assessment of respiratory activity, but otherwise undergo the typical blood donation procedure.
EXPERIMENTAL: Applied Tension; Participants are taught a simple muscle tensing technique with a brief video presented on a notebook computer before giving blood. They are asked to engage in repeated gentle 5-sec on, 5-sec off cycles of whole body isometric muscle tension before and while giving blood.	Behavioral: Applied Tension; Described above.
EXPERIMENTAL: Respiration Control; Participants are taught a simple respiration control technique with a brief video presented on a notebook computer before giving blood. They are asked to breathe in a gentle shallow but regular fashion aimed at reducing risk for hyperventilation before and while giving blood.	Behavioral: Respiration Control; Described above.
EXPERIMENTAL: Applied Tension/Respiration Control; Participants are asked to practice both Applied Tension and Respiration Control before and while giving blood.	Behavioral: Applied Tension/Respiration Control; Described above.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in End Tidal CO2	assessed by ambulatory monitor (capnometer)	change in mean value during the pre-donation waiting period (registration to going to chair, approximately 30 minutes) to the mean value in the donation chair (approximately 15 minutes)
Change in Respiration Rate	assessed by ambulatory monitor (capnometer)	change in mean value during the pre-donation waiting period (registration to going to chair, approximately 30 minutes) to the mean value in the donation chair (approximately 15 minutes)
Blood Donation Reactions Inventory	questionnaire assessing presyncopal vasovagal symptoms	completed in the recovery area, approximately 15 minutes after blood donation
Research Assistant Observations	participant anxiety, fainting, whether or not treatment for a vasovagal response required, etc., noted by a research assistant	during blood donation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Spielberger State Anxiety Scale Score	self-report questionnaire	completed just after registering at the clinic and also in the recovery area, approximately 15 minutes after blood donation, to assess change in anxiety
Medical Fears Survey	self-report questionnaire	completed in the recovery area, approximately 15 minutes after blood donation
Change in Systolic Blood Pressure	in mmHg	measured just after registering at the clinic and also in the recovery area, approximately 15 minutes after blood donation, to assess change in blood pressure
Change in Diastolic Blood Pressure	in mmHg	measured just after registering at the clinic and also in the recovery area, approximately 15 minutes after blood donation, to assess change in blood pressure
Change in Heart Rate	in bpm	measured just after registering at the clinic and also in the recovery area, approximately 15 minutes after blood donation, to assess change in heart rate
Blood Donor Return	number of times the donor returns to give blood again in a one-year time frame as reported by Hema-Quebec	one year after participating in the study

Collaborators and Investigators

• Sponsor: McGill University
• Collaborators: Canadian Institutes of Health Research (CIHR)
• Investigators: Principal Investigator: Blaine Ditto, PhD, Professor

Study record dates

Study Major Dates

• Study Start (ACTUAL): September 15, 2015
• Primary Completion (ANTICIPATED): May 31, 2018
• Study Completion (ANTICIPATED): May 31, 2018

Study Registration Dates

• First Submitted: May 15, 2017
• First Submitted That Met QC Criteria: May 17, 2017
• First Posted (ACTUAL): May 18, 2017

Study Record Updates

• Last Update Posted (ACTUAL): May 18, 2017
• Last Update Submitted That Met QC Criteria: May 17, 2017
• Last Verified: May 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Neurobehavioral Manifestations; Autonomic Nervous System Diseases; Unconsciousness; Consciousness Disorders; Primary Dysautonomias; Orthostatic Intolerance; Syncope; Syncope, Vasovagal
• Other Study ID Numbers: MOP-133459

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No