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Epinephrin-dosis: Optimal Versus Standard Evalueringsforsøg (EpiDOSE)

28. september 2026 opdateret af: Unity Health Toronto

CanROC Epinephrin Dosis: Optimal Versus Standard Evalueringsforsøg (CanROC EpiDOSE Trial)

The objective of this randomized controlled trial is to evaluate whether a low cumulative dose of epinephrine ("low dose") is non-inferior to a standard cumulative dose of epinephrine ("standard dose") with respect to survival to hospital discharge among adults undergoing resuscitation for OHCA due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).

Studieoversigt

Status

Rekruttering

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

This study is designed as a prospective, multicentre, single-blinded randomized controlled trial (RCT) where eligible OHCA patients are randomized to receive a low cumulative dose of epinephrine (low dose epinephrine, up to 2mg total) or a standard cumulative dose of epinephrine (standard dose epinephrine, up to 6mg total) in a 1:1 fashion.

Eligible OHCA patients will be treated by paramedics who will initiate cardiopulmonary resuscitation (CPR) and the delivery of defibrillation shocks per paramedic agencies' treatment protocols. After one defibrillation and when feasible, paramedics will establish peripheral intravenous (IV) access, and patients will be randomly allocated to either the low dose or standard dose treatment arm. Epinephrine doses (according to treatment assignment) will be administered every 3-5 minutes, based on current guidelines and paramedic protocols, until the first return of spontaneous circulation (ROSC) is achieved or if resuscitation has been terminated by the base hospital physician. Other medications (e.g. antiarrhythmics, magnesium, beta blockers) and interventions (e.g. intubation) may be interposed as required. Follow-up will take place using a combination of administrative databases (e.g. the Discharge Abstract Database and the National Ambulatory Care Reporting System) and telephone interviews.

This RCT will evaluate a fundamental change in the treatment of OHCA. The investigators hypothesize that a low cumulative dose of epinephrine will improve patient survival to hospital discharge compared to a standard cumulative dose of epinephrine. Please feel free to contact epidose@unityhealth.to for further information.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

1250

Fase

  • Fase 4

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Studiesteder

    • British Columbia
      • Victoria, British Columbia, Canada, V8W 9P1
        • Rekruttering
        • British Columbia Emergency Health Services (BCEHS)
        • Ledende efterforsker:
          • Brian Grunau, MD
        • Kontakt:
    • Ontario
      • Brampton, Ontario, Canada, L6T 4B9
        • Rekruttering
        • Peel Regional Paramedic Services
        • Ledende efterforsker:
          • Sheldon Cheskes, MD
        • Kontakt:
      • London, Ontario, Canada, N6E 1R4
        • Rekruttering
        • Middlesex-London Paramedic Service
        • Ledende efterforsker:
          • Christian Vaillancourt, MD
        • Kontakt:
        • Underforsker:
          • Matthew Davis, MD
      • Oakville, Ontario, Canada, L6M 3L1
        • Rekruttering
        • Halton Region Paramedic Services
        • Ledende efterforsker:
          • Sheldon Cheskes, MD
        • Kontakt:
      • Ottawa, Ontario, Canada, K1H 1E2
        • Rekruttering
        • Ottawa Paramedic Services
        • Ledende efterforsker:
          • Christian Vaillancourt, MD
        • Kontakt:
      • Thunder Bay, Ontario, Canada, P7B 4X6
        • Rekruttering
        • Superior North Emergency Medical Services
        • Ledende efterforsker:
          • Christian Vaillancourt, MD
        • Kontakt:
        • Underforsker:
          • David Savage, MD
      • Waterloo, Ontario, Canada, N2G 4J3
        • Rekruttering
        • Region of Waterloo Paramedic Services
        • Kontakt:
        • Ledende efterforsker:
          • Paul Miller, MD
      • Windsor, Ontario, Canada, N9A 1N6
        • Rekruttering
        • Essex-Windsor Emergency Health Services
        • Ledende efterforsker:
          • Christian Vaillancourt, MD
        • Kontakt:
    • Saskatchewan
      • Saskatoon, Saskatchewan, Canada, S7J 4M2
        • Rekruttering
        • Medavie Health Services West
        • Kontakt:
        • Ledende efterforsker:
          • Andrew Leach, MD

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Out-of-hospital cardiac arrest treated by paramedics AND
  • Initial recorded cardiac rhythm of VF or pulseless VT, or, AED shock on first analysis administered or confirmed by paramedics or fire services, AND
  • Established intravenous vascular access

Exclusion Criteria:

  • Known or apparent age <18 years
  • Initial recorded cardiac rhythm of VF or pulseless VT, or, AED shock on first analysis administered or confirmed by paramedics
  • Cardiac arrest due to an obvious non-cardiac primary cause (e.g. blunt or penetrating trauma, exsanguination, burns, drug overdose, drowning, anaphylaxis, sudden asphyxiation, etc.)
  • Administration of intramuscular, endotracheal tube, or intraosseous epinephrine
  • Prisoners or persons in police custody
  • Known allergy or sensitivity to epinephrine

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Tredobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: Low Dose Epinephrine

Epinephrine up to 2mg total

Epinephrine 1mg 1:10000 (10cc) per dose

Andre navne:
  • Adrenalin
Aktiv komparator: Standard Dose Epinephrine

Epinephrine up to 6mg total

Epinephrine 1mg 1:10000 (10cc) per dose

Andre navne:
  • Adrenalin

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Survival to hospital discharge
Tidsramme: Through study completion (up to 5 years)

Individuals discharged alive from hospital

Through study completion (up to 5 years)

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Return of spontaneous circulation in out-of-hospital setting
Tidsramme: Through study completion (up to 5 years)

Return of spontaneous circulation in the field

Through study completion (up to 5 years)
Survival to emergency department arrival
Tidsramme: Through study completion (up to 5 years)

Individuals alive upon arrival to a hospital emergency department

Through study completion (up to 5 years)
Survival to admission with death prior to discharge
Tidsramme: Through study completion (up to 5 years)

Individuals alive upon hospital admission who die in-hospital before being discharged

Through study completion (up to 5 years)
Survival to discharge outside of a long-term healthcare facility e.g. nursing home
Tidsramme: Through study completion (up to 5 years)

Individuals discharged alive from hospital to a care facility

Through study completion (up to 5 years)
Modified Rankin Scale (mRS) score
Tidsramme: 12+/-3 months

Assessment of neurological function, scores range from 0 to 6 where higher scores indicate worse neurological function (0=no symptoms, 6=dead)

12+/-3 months
Health Utility Index-3 (HUI-3) score
Tidsramme: 12+/-3 months

Assessment of quality of life, scores range from -0.36 to 1 where higher scores indicate better quality life (negative scores=a state worse than being dead, 0=dead, 1=perfect health)

12+/-3 months
Hospital Anxiety and Depression Scale score
Tidsramme: 12+/-3 months

Assessment of quality of life, scores range from 0 to 21 where higher scores indicate more anxiety/depression

12+/-3 months
Length of stay in hospital
Tidsramme: Through study completion (up to 5 years)

Length of time an individual remained in-hospital (length in days)

Through study completion (up to 5 years)
Length of stay in critical care unit
Tidsramme: Through study completion (up to 5 years)

Length of time an individual remained in a crucial care unit (length in days)

Through study completion (up to 5 years)
Survival post-arrest
Tidsramme: Up to 5 years

Survival following hospital discharge, up to 5 years

Up to 5 years
Recurrent cardiac arrest(s)
Tidsramme: Up to 5 years

Number of cardiac arrests following the index arrest

Up to 5 years
ICD implant post-arrest
Tidsramme: Up to 5 years

Whether an implantable cardioverter defibrillator was implanted post-arrest

Up to 5 years
Cardiovascular re-hospitalization(s)
Tidsramme: Up to 5 years

Number of cardiovascular re-hospitalizations

Up to 5 years
All-cause re-hospitalizations(s)
Tidsramme: Up to 5 years

Number of re-hospitalizations for any reason

Up to 5 years

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Samarbejdspartnere

Efterforskere

  • Ledende efterforsker: Paul Dorian, MD, MSc, Unity Health Toronto
  • Ledende efterforsker: Steve Lin, MD, MSc, Unity Health Toronto

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

24. maj 2023

Primær færdiggørelse (Anslået)

1. december 2028

Studieafslutning (Anslået)

1. december 2028

Datoer for studieregistrering

Først indsendt

7. november 2018

Først indsendt, der opfyldte QC-kriterier

30. januar 2019

Først opslået (Faktiske)

1. februar 2019

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

2. oktober 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

28. september 2026

Sidst verificeret

1. december 2025

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • EpiDOSE Protocol Version 4.0

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

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Ingen

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Ingen

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