- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04582396
Stellate Ganglion Blockade to Reduce Cardiac Anxiety and PTSD Symptoms in Cardiac Arrest Survivors (SGB-PsychoED)
A Pilot Study of Stellate Ganglion Blockade + Psychoeducation to Reduce Cardiac Anxiety and PTSD Symptoms in Cardiac Arrest Survivors
This is a pilot randomized controlled trial (RCT) to gain preliminary evidence regarding the acceptability, tolerability, safety, and efficacy of a combined intervention of Stellate Ganglion Blockade (SGB) and psychoeducation on trauma symptoms and health behaviors in patients exhibiting early PTSD symptoms after cardiac arrest (CA).
Primary Aim 1 (Feasibility outcomes): Gain preliminary evidence regarding the acceptability, tolerability, and safety of conducting a randomized trial that evaluates a single SGB treatment in conjunction with psychoeducation among CA patients with early PTSD symptoms.
Secondary Aim 1 (Treatment-related outcomes): Test, whether SGB/psychoeducation treatment in CA patients with clinically significant PTSD symptoms is associated with reduced cardiac anxiety, PTSD symptoms, and improved health behaviors (physical activity and sleep duration), assessed objectively by a wrist-worn accelerometer for 4 weeks post-discharge.
Study Overview
Status
Intervention / Treatment
Detailed Description
Every year in the U.S., 500,000 people experience sudden cardiac arrest (CA), caused by electrical disturbances across cardiac tissue, leading to marked arrhythmia that ultimately results in the heart ceasing to pump blood to the brain, lungs, and other organs. Due to advances in bundled post-arrest care, cardio-cerebral resuscitation, and effective cooling protocols, a substantial proportion of patients who receive guideline-based care (nearly 1 in 3 for out-of-hospital and ~50% for in-hospital CA) now survive this once universally fatal condition. While most survivors retain their cognitive function and physical independence, many grapple with CA's psychological consequences in the context of learning that they were "clinically dead."
In particular, many describe the CA experience as traumatic, and up to 1 in 3 CA survivors subsequently develop posttraumatic stress disorder (PTSD). Not only is PTSD common in CA patients, but there is evidence that PTSD after CA may influence health behaviors and prognosis.
Treatment of early PTSD and cardiac anxiety symptoms after CA requires timely intervention. Recent studies show that SGB is a safe and acceptable intervention for reducing PTSD symptoms in combat veterans. SGB treatment has never been tested to treat PTSD induced by acute medical events such as CA.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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New York
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New York, New York, United States, 10032
- Columbia University Medical Center/New York Presbyterian
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion criteria
- Age 18 years or older
- Fluent in English or Spanish
- A diagnosis of cardiac arrest (CA)
- Admitted to the New York-Presbyterian Hospital
- Elevated symptoms of psychological distress a. PCL-5 > 32 with a minimum of 2 weeks after cardiac arrest
Exclusion criteria
- A prior SGB treatment
- Severe brain injury defined as Cerebral Performance Category Score ≥3, and/or significant aphasia, dysarthria, or cognitive impairment precluding ability to complete study questionnaires as determined by interviewer
- Terminal non-cardiovascular illness (life expectancy <1 year)
- Severe mental illness requiring urgent psychiatric hospitalization
- Alcohol or substance abuse that would impede ability to complete study
- Unavailable for telephone and in-person follow-up
- Allergy to amide local anesthetics (e.g., ropivacaine, bupivacaine)
- Pre-existing Horner's syndrome
- Pregnancy
- Current anticoagulant use
- History of a bleeding disorder
- Infection or mass at injection site
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Stellate Ganglion Block + Psychoeducation
For the active SGB arm, 7 to 8 mL of ropivacaine, 0.5%, will be injected around and into the site of the ganglion once before the hospital discharge.
They will also receive a 30 minutes session of psychoeducation by a health professional with experience working with CA patients.
|
A stellate ganglion block (SGB) is an injection of local anesthetic (numbing medicine) to block the nerves located on either side of the voice box in the neck.
It will be administered in an inpatient monitored setting.
Other Names:
The session will be 30 minutes in duration, to be administered by a health professional with experience working with CA patients, the goal will be to establish rapport and help patient identify anxious situations, thoughts, and bodily feelings related their recent CA that could lead to avoidant behavior. Explain how many of these feelings are common in CA survivors, and they are often unrelated to their risk of its recurrence. Explain how the body has a fight-or-flight system that is controlled in part by the stellate ganglion and explain how blocking the action of this part of the body can reduce the feelings of anxiety that commonly occur. Discuss how certain activities such as exercise can increase feelings of anxiety around bodily sensations, but continued engagement could reduce that fear and that exercise is helpful for recovering from CA |
Placebo Comparator: Normal saline injection + Psychoeducation
For the sham procedure, 1 to 2 mL of preservative-free normal saline will be injected into deep musculature in the neck.
They will also receive a 30 minutes session of psychoeducation by a health professional with experience working with CA patients.
|
The session will be 30 minutes in duration, to be administered by a health professional with experience working with CA patients, the goal will be to establish rapport and help patient identify anxious situations, thoughts, and bodily feelings related their recent CA that could lead to avoidant behavior. Explain how many of these feelings are common in CA survivors, and they are often unrelated to their risk of its recurrence. Explain how the body has a fight-or-flight system that is controlled in part by the stellate ganglion and explain how blocking the action of this part of the body can reduce the feelings of anxiety that commonly occur. Discuss how certain activities such as exercise can increase feelings of anxiety around bodily sensations, but continued engagement could reduce that fear and that exercise is helpful for recovering from CA
An injection of normal saline will be injected into muscle on either side of the voice box in the neck.
It will be administered in an inpatient monitored setting.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of eligible subjects who get enrolled in the trial
Time Frame: Baseline (pre-procedure)
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This is designed to measure the feasibility of successful enrollment.
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Baseline (pre-procedure)
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Number of patients recruited per month
Time Frame: Assessed at 10 Month from the beginning of enrollment
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This is designed to measure the rate of enrollment, with <4 patients/month considered not meeting outcome
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Assessed at 10 Month from the beginning of enrollment
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Proportion of participants who complete the 4-weeks assessments
Time Frame: Study Completion (Approximately 11 months)
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This is designed to assess the short-term attrition and lost to follow-up up to 4 weeks post-enrollment.
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Study Completion (Approximately 11 months)
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Proportion of participants who complete the 12-weeks assessments
Time Frame: Assessed at 12-weeks post-procedure
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This is designed to assess the long-term attrition and lost to follow-up up to 12 weeks post-enrollment.
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Assessed at 12-weeks post-procedure
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Proportion of participants who develop one or more signs of Horner's syndrome
Time Frame: Assessed at baseline post-procedure
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Horner's syndrome density grading scale will be used to assess treatment fidelity
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Assessed at baseline post-procedure
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Treatment expectancy questionnaire
Time Frame: Assessed at baseline, post-procedure
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Treatment credibility will be assessed.
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Assessed at baseline, post-procedure
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The proportion of participants completing the check-list of various components of Psychoeducation
Time Frame: Assessed at baseline post-procedure
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This is designed to assess the feasibility of administering psychoeducation, with >80% of the components in the checklist as a threshold for success.
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Assessed at baseline post-procedure
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The proportion of participants with >80% of the total actigraph wear time
Time Frame: Assessed at 4-weeks post-procedure
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It is designed to assess the acceptability of actigraphy
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Assessed at 4-weeks post-procedure
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The proportion of participants with clinically significant symptoms of Posttraumatic Stress Disorder (PCL-5)
Time Frame: Assessed pre-procedure and then repeated at 4-weeks post-procedure
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The Effect of SGB-PsychoED intervention on PTSD symptoms will be assessed using PCL-5.
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Assessed pre-procedure and then repeated at 4-weeks post-procedure
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The proportion of participants with clinically significant symptoms of Cardiac anxiety
Time Frame: Assessed pre-procedure and then repeated at 4-weeks post-procedure
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The effect of SGB-PsychoED intervention on cardiac anxiety will be assessed using cardiac anxiety questionnaire (CAQ)
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Assessed pre-procedure and then repeated at 4-weeks post-procedure
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The proportion of participants with clinically significant symptoms of Generalized anxiety disorder.
Time Frame: Assessed pre-procedure and then repeated at 4-weeks post-procedure
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The effect of SGB-PsychoED intervention on generalized anxiety disorder will be assessed using generalized anxiety disorder scale-7 (GAD-7)
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Assessed pre-procedure and then repeated at 4-weeks post-procedure
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The proportion of participants with clinically significant symptoms of depression.
Time Frame: Assessed pre-procedure and then repeated at 4-weeks post-procedure
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The effect of SGB-PsychoED intervention on depression will be assessed using the eight-item Patient Health Questionnaire depression scale (PHQ-8).
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Assessed pre-procedure and then repeated at 4-weeks post-procedure
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The proportion of participants with moderate to high levels of physical activity.
Time Frame: Assessed at 4-weeks post-discharge
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Effect of SGB-PsychoED intervention on mean minutes/day of physical activity as measured by the objective actigraphy data
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Assessed at 4-weeks post-discharge
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The proportion of participants with reduced duration of sleep.
Time Frame: Assessed at 4-weeks post-discharge
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Effect of SGB-PsychoED intervention on mean hours/day of sleep as measured by the objective actigraphy data
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Assessed at 4-weeks post-discharge
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Sachin Agarwal, MD, MPH, Columbia University/New York Presbyterian
- Study Director: Ian M Kronish, MD, MPH, Columbia University
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 (Actual)
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
- AAAS8305
- 5P30AG064198-02 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- Study Protocol
- Statistical Analysis Plan (SAP)
- Informed Consent Form (ICF)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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