Ossigenoterapia standard vs mirata preospedaliera per broncopneumopatia cronica ostruttiva (STOP-COPD)
The STOP-COPD trial is a randomized, patient-blinded, prehospital clinical trial designed to evaluate the effect of titrated oxygen therapy compared to standard oxygen treatment in patients with suspected acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treated with inhaled bronchodilators. The primary objective is to determine whether a titrated oxygen strategy targeting SpO₂ 88-92% can reduce 30-day mortality compared to the current standard practice using 100% compressed oxygen as a nebulizer driver.
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally. In the prehospital setting, patients with suspected acute exacerbation of COPD (AECOPD) are frequently treated with inhaled bronchodilators driven by 100% oxygen, despite concerns that high-concentration oxygen therapy may worsen hypercapnia and acidosis, leading to increased mortality.
The STOP-COPD trial is a prospective, randomized, parallel-group, superiority trial conducted in the Prehospital Emergency Medical Services, Central Denmark Region. Patients aged 40 years or older with suspected AECOPD requiring inhaled bronchodilators are randomized 1:1 to receive either:
Titrated oxygen therapy: Inhaled bronchodilators driven by compressed air with supplemental oxygen titrated to maintain SpO₂ 88-92%.
Standard treatment: Inhaled bronchodilators driven by 100% compressed oxygen according to standard protocols.
The primary outcome is 30-day all-cause mortality. Secondary outcomes include 24-hour and 7-day mortality, need for invasive or non-invasive ventilation, development of respiratory acidosis upon hospital arrival, ICU admission rate, length of hospital and ICU stay, patient-experienced dyspnoea, and readmission rates. A total of 1,888 patients will be enrolled.
The study is conducted under emergency research regulations allowing enrolment before informed consent, with consent obtained as soon as feasible after hospital admission. This trial seeks to evaluate whether titrating oxygen delivery in the prehospital phase can improve survival and clinical outcomes for patients with AECOPD.
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Fase
Fase
- Fase 4
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: Martin F Gude, PhD
- Numero di telefono: 0045 25343621
- Email: martgude@rm.dk
Backup dei contatti dello studio
- Nome: Arne Sylvester R Jensen
- Numero di telefono: 22396968
- Email: arjens@rm.dk
Luoghi di studio
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Aarhus N, Danimarca, 8200
- Reclutamento
- Prehospital Emergency Medical Servises, Central Denmark Region
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Patients over the age of 40
- EMT or Paramedic suspected AECOPD
- Confirmed suspicion of COPD
Exclusion Criteria:
- Bronchospasm due to asthma, allergic reaction or non-COPD conditions
- Known or suspected pregnancy
- Prehospital Non-invasive, invasive or assisted bag mask ventilation
- Allergy to inhaled bronchodilators (Salbutamol)
- Inter-hospital transfer
- More than 2 doses (5 mg salbutamol) inhalation drug, acute treatment by EMS (emergency medical service) personnel, before allocated treatment is initiated
- Suspicion of acute coronary syndrome
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Separare
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
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Sperimentale: Titrated Oxygen
If the treating EMT or paramedic finds indications for inhaled bronchodilators, this will be done with compressed air 6-8 l/min. as the driver for the nebulizer. The patient will have a Bi-nasal EtCO2 (end-tidal carbon dioxide) meter placed under the nebulizer. This will measure the EtCO2 during the treatment and at the same time oxygen can be titrated through this to a target SpO2 of 88-92%. Repeated treatment will be at the discretion of the treating EMT or paramedic according to SOP (standard operating procedures). Following scenarios regarding SpO2 can occur during treatment: SpO2 <88%: Supplemental oxygen via the EtCO2-meter up to 10 l/min, if higher oxygen levels are needed oxygen will be used as driver for the nebulizer. If the SpO2 remains under 88% additional oxygen can be added via the EtCO2-meter. SpO2 88-92%: No intervention. SpO2 >92%: No intervention. If repeated treatment is not indicated the patient receives oxygen to SpO2 88-92% according SOP. |
Titrated oxygen strategy - a mix of supplemental oxygen and compressed atmospheric air as driver for inhaled bronchodilators to target SpO2 88-92%
Altri nomi:
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Comparatore attivo: Standard Oxygen
If the treating EMT or paramedic finds indication for inhaled bronchodilators, this will be done with oxygen 6-8 l/min. as the driver for the nebulizer. The patient will have a Bi-nasal EtCO2 meter placed under the nebulizer. This will measure the EtCO2 during the treatment and at the same time mask the patient for group allocation. Repeated treatment will be at the discretion of the treating EMT or paramedic according to SOP. Following scenarios regarding SpO2 can occur during treatment: SpO2 <88%: Supplemental oxygen via the EtCO2 -meter up to 10 l/min. SpO2 88-92%: No intervention. SpO2 >92%: No intervention. If repeated treatment is not indicated the patient receives oxygen to SpO2 88-92% according SOP. |
Standard care using compressed oxygen (100%) as driver for inhaled bronchodilators
Altri nomi:
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
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Mortality, 30-day
Lasso di tempo: Day 30 from randomization
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Vital status assessed 30 days after randomization using hospital electronic medical records |
Day 30 from randomization
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Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Mortality, 24-hour
Lasso di tempo: 24 hours from randomization
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Vital status assessed 24 hours after randomization using hospital electronic medical records |
24 hours from randomization
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Mortality, 7-day
Lasso di tempo: Day 7 from randomization
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Vital status assessed 7 days after randomization using hospital electronic medical records |
Day 7 from randomization
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Length of hospital stay
Lasso di tempo: Day 30 from randomization
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Number of days from hospital admission to hospital discharge, collected from hospital electronic medical records |
Day 30 from randomization
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ICU admission rate
Lasso di tempo: Day 30 from randomization
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Proportion of patients admitted to an intensive care unit during the index hospitalization, collected from the electronic hospital medical record |
Day 30 from randomization
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Length of ICU stay
Lasso di tempo: Day 30 from randomization
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Number of days spent in the intensive care unit during the index hospitalization, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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In-hospital need for NIV (non-invasive ventilation) within 24 hours
Lasso di tempo: Day 30 from randomization
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Use of non-invasive ventilation recorded within 24 hours of hospital admission, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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In-hospital need for NIV within 7 days
Lasso di tempo: Day 30 from randomization
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Use of non-invasive ventilation recorded within 7 days of hospital admission, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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In-hospital need for NIV within 30 days
Lasso di tempo: Day 30 from randomization
|
Use of non-invasive ventilation recorded within 30 days of randomization, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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Time to NIV
Lasso di tempo: Day 30 from randomization
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Time from hospital admission to initiation of non-invasive ventilation, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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In-hospital need for invasive mechanical ventilation within 24 hours
Lasso di tempo: Day 30 from randomization
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Initiation of invasive mechanical ventilation within 24 hours of hospital admission, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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In-hospital need for invasive mechanical ventilation within 7 days
Lasso di tempo: Day 30 from randomization
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Initiation of invasive mechanical ventilation within 7 days of hospital admission, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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In-hospital need for invasive mechanical ventilation within 30 days
Lasso di tempo: Day 30 from randomization
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Initiation of invasive mechanical ventilation within 30 days of randomization, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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Time to invasive ventilation
Lasso di tempo: Day 30 from randomization
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Time from hospital admission to initiation of invasive mechanical ventilation, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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Proportion of patients with respiratory acidosis on arrival to hospital
Lasso di tempo: Day 30 from randomization
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Presence of respiratory acidosis (PaCO₂ >6.3 kPa and pH <7.35) assessed via arterial blood gas analysis within 30 minutes after arrival, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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The degree of acidosis based on the pH (potential of hydrogen) value
Lasso di tempo: Day 30 from randomization
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Lowest pH value measured from arterial blood gas within 30 minutes of hospital arrival, collected from the patient's electronic hospital medical record |
Day 30 from randomization
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Patient experienced dyspnoea on a verbal rating scale 0-10
Lasso di tempo: Day 30 from randomization
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Patient-reported dyspnoea score at hospital arrival on a scale from 0 (no dyspnoea) to 10 (worst imaginable dyspnoea), collected from the prehospital patient record and hospital medical record |
Day 30 from randomization
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Readmission rate
Lasso di tempo: Day 30 after discharge
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Proportion of patients readmitted to hospital within 30 days after discharge from index hospitalization, collected from the patient's electronic hospital medical record |
Day 30 after discharge
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Time to readmission
Lasso di tempo: Day 30 after discharge
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Number of days from hospital discharge to first hospital readmission within 30 days, collected from the patient's electronic hospital medical record |
Day 30 after discharge
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Collaboratori e investigatori
Sponsor
Sponsor
Investigatori
Investigatori
- Investigatore principale: Martin F Gude, PhD, Central Denmark Region
Pubblicazioni e link utili
Studiare le date dei record
Studia le date principali
Inizio studio (Effettivo)
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- 5925
- 2022-502003-30-00 (Altro identificatore: https://euclinicaltrials.eu)
Piano per i dati dei singoli partecipanti (IPD)
Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?
Descrizione del piano IPD
De-identified individual participant data (IPD) will be made available to researchers whose proposed use of the data has been approved by the local administration. Data will be shared starting 9 months after publication of the primary results and will be accessible until data are no longer stored, according to current ICMJE recommendations and EU data protection regulations.
All trial-related documents (e.g., protocol, statistical analysis plan) will be made publicly available on the trial website. Patient-related data will not be accessible on the website.
Periodo di condivisione IPD
9 months after primary results publication; data will remain available until de-identified data are no longer stored according to ICMJE recommendations and EU regulations.
Criteri di accesso alla condivisione IPD
Researchers must submit a methodologically sound proposal for use of the data. Access will be granted following review and approval by the local trial administration. A data-sharing agreement will be required.
Tipo di informazioni di supporto alla condivisione IPD
- STUDIO_PROTOCOLLO
- LINFA
- ICF
- CODICE_ANALITICO
- RSI
Informazioni su farmaci e dispositivi, documenti di studio
Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti
Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
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