Drowning-related Acute Respiratory Failure (CPAPDROWNING)

Evaluation of Non-Invasive Ventilation/Continuous Positive Airway Pressure for Drowning-related Acute Respiratory Failure

The purpose of this study is to assess the Non-Invasive Ventilation-Continuous Positive Airway Pressure efficacy (experimental group) for drowning related Acute Respiratory Failure compared to Oxygen Supply by face mask (15Liters/minutes) (control group).

Study Overview

• Status: Recruiting
• Conditions: Drowning
• Intervention / Treatment: Procedure: Emergency Medical Service intervention : Oxygen Supply strategy; Procedure: Emergency Medical Service intervention : Continuous Positive Airway Pressure strategy

Detailed Description

Open-label, multicenter, prospective, cross-over cluster randomized (ratio 1:1), conducted in 16 Emergency Medical Service centers in France :

• Experimental group: Non-Invasive Ventilation-Continuous Positive Airway Pressure (Arm 1)
• Control group: Oxygen Supply by face mask (Arm 2)

Drowning-related acute respiratory failure has important clinical consequences (4 to 18% mortality). No national/international medical consensus exist for its management.

Our team has successively demonstrated that:

• The acute respiratory failure related to drowning in salt or fresh water presented the same clinical pathway and prognosis ;
• Most victims with drowning related acute respiratory failure do no present hemodynamic instability ;
• If the oxygenation is rapidly improved, neurological status is also maintained in acute respiratory failure victims ;
• Pediatric and adult presentations are similar.

Facing an acute respiratory failure, emergency medical service must rapidly choose between oxygen supply by face mask (15 liters /minutes), mechanical ventilation or non-invasive ventilation. mechanical ventilation as non-invasive ventilation present interests and side arms. No comparative study has been conducted between these strategies. The arguments for non-invasive ventilation use specifically in a continuous positive airway pressure mode are:

• Fast recovery of acute respiratory failure in 24h
• Retrospective publications showing that the benefit of non-invasive ventilation probably based on continuous positive airway pressure mode
• Easy implementation of continuous positive airway pressure in the pre-hospital setting (adults, children, newborns)
• Complexity of mechanical ventilation in pre-hospital setting. Our working hypothesis is the efficacy of early use of non-invasive ventilation-continuous positive airway pressure in drowning related acute respiratory failure.

• Study Type: Interventional
• Enrollment (Estimated): 210
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Pierre Michelet, MD; Phone Number: +33 638741313; Email: pierre.michelet@ap-hm.fr

Study Locations

• France
  • Bayonne, France
    • Recruiting
    • Centre Hospitalier de la Côte Basque - Urgences
    • Contact: LABES, MD
  • Bordeaux, France
    • Recruiting
    • Groupe Hospitalier PELLEGRIN - SAMU-SMUR
    • Contact: Bruno SIMONNET, MD
  • La Rochelle, France
    • Recruiting
    • CH La Rochelle - Urgence
    • Contact: Ombeline SUSONG, MD
  • Les Sables-d'Olonne, France
    • Recruiting
    • Centre Hospitalier Côte de Lumière - SAMU/SMUR 85
    • Contact: Stanislas BAWEJSKI, MD
  • Marseille, France, 13005
    • Not yet recruiting
    • CHU Timone - APHM
    • Contact: Pierre Michelet, MD; Phone Number: +33 638741313; Email: pierre.michelet@ap-hm.fr
  • Montpellier, France
    • Recruiting
    • CHU de Montpellier - Hôpital Lapeyronie
    • Contact: Mustapha SEBBANE, MD
  • Nantes, France
    • Recruiting
    • CHU de Nantes - Urgences/SAMU
    • Contact: Emmanuel MONTASSIER, MD
  • Nice, France
    • Recruiting
    • CHU Nice Hôpital Pasteur
    • Contact: Céline OCCELLI, MD
  • Toulon, France, 83053
    • Recruiting
    • CHITS Hôpital Ste Musse
    • Contact: Muriel Vergne, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Man/boy or woman/girl, 1yo and older.
• Subject suffering from drowning related-Acute Respiratory Failure (whatever the nature of water, salt or fresh) and benefiting from the Emergency Medical Service intervention;

• Acute Respiratory Failure defined as the presence of:

  • Capillary O2 saturation <92% upon Emergency Medical Service first clinical analysis at the drowning scene;
  • Need for oxygen supply 15Liters/minutes to reach capillary O2 saturation ≥ 95%;
  • Combination of Acute Respiratory Failure clinical signs: at least 1 of the following items: respiratory rate >30/min, sternal or clavicular indrawing, abdominal breathing, cyanosis.
• Individual affiliated to or beneficiary of a French health insurance system;
• Individual with the ability to benefit from the two strategies (ambivalence clause);
• Adult Individual having signed written informed consent or child subject with an authorization of the parents.

Exclusion Criteria:

• Individual with hypothermia ≤ 34°C ;
• Individual with neurological distress defined by a Glasgow Coma Scale < 13 at first clinical assessment and during the first 15 minutes of care ;
• Individual with hemodynamic distress defined by a systolic blood tension < 90 mmHg at first clinical assessment and during the first 15 minutes of care ;
• Cardiac arrest or respiratory arrest ;
• Declared pregnancy or breastfeeding ;
• Patient under legal protection regime for adults.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: the Oxygen Supply strategy	Procedure: Emergency Medical Service intervention : Oxygen Supply strategy; During the 4-month period of control, the care teams will: - Use Oxygen Supply by face mask (15Liters/minutes) from pre-hospital to intensive care unit admission until the 6th hour following the start of drowning care (Emergency Medical Service arrival at the scene). Indeed, current concepts of advanced prehospital care include the use of oxygen by face mask (15Liters/minutes) and intubation-Mechanical Ventilation in case of failure. The requirement of intubation-Mechanical Ventilation by the Emergency Medical Service (pre-hospital phase) or Intensive Care Unit (hospital phase) practitioners during this first 6 hours period will be left to the discretion of the practitioners in charge of the patient; - Continue this strategy in the Intensive Care Unit until the Acute Respiratory Failure resolution allows a reduction of Oxygen Supply. The Oxygen Supply will be reduced progressively litter by litter each 12 hours period with maintenance of capillary saturation up to 92%.
Experimental: the Continuous Positive Airway Pressure strategy	Procedure: Emergency Medical Service intervention : Continuous Positive Airway Pressure strategy; During the 4-month period of experimentation, the care teams will: - Use Non-Invasive Ventilation by Continuous Positive Airway Pressure (set between 8 to 10 cm H2O) from pre-hospital setting to Intensive Care Unit admission until the 6th hour following the start of drowning care (Emergency Medical Service arrival at the scene). The requirement of Mechanical Ventilation by the Emergency Medical Service (pre-hospital phase) or Intensive Care Unit (hospital phase) practitioners during this first 6 hours period will be left to the discretion of the practitioners in charge of the patient. - Continue this strategy in the Intensive Care Unit until the Acute Respiratory Failure resolution allows a reduction of Non-Invasive Ventilation-Continuous Positive Airway Pressure. Non-Invasive Ventilation-Continuous Positive Airway Pressure support will be weaned progressively (left at practitioners' convenience) with maintenance of capillary O2 saturation up to 92%.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inability to improve oxygen saturation up than 92%	Indication of intubation/mechanical ventilation requirement in the first 6 hours based on following criteria : Inability to improve oxygen saturation up than 92% despite the ventilatory strategy used;	6 hours
Glasgow Coma Scale	Indication of intubation/mechanical ventilation requirement in the first 6 hours based on following criteria : Glasgow Coma Scale < 13	6 hours
Cardiac arrest occurrence	Indication of intubation/mechanical ventilation requirement in the first 6 hours based on following criteria : Cardiac arrest occurrence	6 hours
Systolic arterial pressure	Indication of intubation/mechanical ventilation requirement in the first 6 hours based on following criteria : Systolic arterial pressure < 90 mmHg	6 hours
Aspiration	Indication of intubation/mechanical ventilation requirement in the first 6 hours based on following criteria : Aspiration	6 hours

Collaborators and Investigators

• Sponsor: Assistance Publique Hopitaux De Marseille

Study record dates

Study Major Dates

• Study Start (Actual): July 24, 2024
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: December 5, 2023
• First Submitted That Met QC Criteria: December 13, 2023
• First Posted (Actual): December 28, 2023

Study Record Updates

• Last Update Posted (Actual): February 6, 2026
• Last Update Submitted That Met QC Criteria: February 3, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries; Pathologic Processes; Death; Pathological Conditions, Signs and Symptoms; Drowning
• Other Study ID Numbers: 2023-A01181-44

Drug and device information, study documents

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