Impact of Intracoronary Versus Intravenous Epinephrine Administration During Cardiac Arrest .

Completed

• Conditions: Cardiopulmonary Arrest; Epinephrine Causing Adverse Effects in Therapeutic Use
• Interventions: Drug: Epinephrin

• Registration Number: NCT05253937
• Lead Sponsor: Lithuanian University of Health Sciences

Brief Summary

In hospital cardiac arrest (IHCA) is a major challenge imposed on almost all health care systems worldwide. Despite significant progress in cardiopulmonary resuscitation in the past few years, outcomes remain relatively poor with an approximate 49 % survival rate.

Epinephrine administration remains a cornerstone in the treatment of cardiac arrest. However, the preferred route of administration remains a matter of debate within the medical community .

Various routes of administration, including intravenous, intramuscular, intraosseous and endotracheal routes have been studied.

Initially, American guidelines for the treatment of cardiac arrest recommended injection of 0.5 mg of epinephrine directly into the right ventricle through the parasternal approach, aiming to achieve higher peak intracardiac concentrations and a more central effect, however the intravenous route remained preferable due to its feasibility and safety .

To our knowledge, intra-coronary epinephrine administration for intraprocedural cardiac arrest has not been evaluated or compared with other routes of administration.

Detailed Description

Not available

Study Timeline

• Study Start: 2018-04-01
• Primary Completion: 2021-06-01
• Study First Submitted: 2022-01-23
• Study First Submitted QC: 2022-02-14
• Study First Posted: 2022-02-24
• Study Completion: 2022-06-01
• Status Verified: 2022-08
• Last Update Submitted: 2022-08-15
• Last Update Posted: 2022-08-16

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 160

Inclusion Criteria

• Aged above 18 years old
• Diagnosed with non-ST elevation myocardial infarction (NSTEMI) or ST elevation myocardial infarction (STEMI)
• Received dual antiplatelet therapy (acetylsalicylic acid and ticagrelor), or triple therapy (oral anticoagulant, acetylsalicylic acid and clopidogrel)
• Event of cardiac arrest during percutaneous intervention

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Exclusion Criteria

• cardiac arrest documented prior to being transported to cardiac catheterization laboratory.
• Patients who suffered cardiac arrest for less than 60 seconds were excluded from the study.
• Received mechanical circulatory support such as intra-aortic balloon pump, temporary percutaneous ventricular assist devices, or extracorporeal membrane oxygenation (ECMO) during hospitalization.
• Presenting with any cardiac rhythm on admission other than sinus rhythm or atrial fibrillation/flutter
• Signs of infection or a history of hepatic, oncologic or allergy to contrast media and end stage renal failure
• Patients who underwent primary fibrinolysis.
• Furthermore, patients who received atropine, amiodarone, lidocaine, or any other antiarrhythmic prior to CPR
• who received targeted temperature management post CPR .

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Intracoronary Epinephrine administration during cardiac arrest	Epinephrin	-
Peripheral intravenous Epinephrine administration during cardiac arrest	Epinephrin	-
Central intravenous Epinephrine administration during cardiac arrest	Epinephrin	-

Primary Outcome Measures

Name	Time	Method
ROSC (return of spontaneous circulation) between different routes of epinephrine administration.	Up to 24 hours	Return of sinus rhythm or atrial fibrillation/flutter for more than 5 minutes (through ECG monitoring)

Secondary Outcome Measures

Name	Time	Method
Survival to hospital discharge with favorable neurologic status (CPC score1-2)	Up to 30 days	Cerebral Performance Category (CPC) - a five point scale that ranges from good cerebral performance (1) to brain death (5), is often used and is commonly dichotomized into "good" (CPC 1-2) versus "poor" (CPC 3-5) outcome .

Trial Locations

Locations (1)

Ali Aldujeli; 🇱🇹 Kaunas, Lithuania