Impact of Intracoronary Versus Central and Peripheral Intravenous Epinephrine Administration During Cardiac Arrest in The Cardiac Catheterization Laboratory for Acute Myocardial Infarction Patients.
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 160
- 试验地点
- 1
- 主要终点
- ROSC (return of spontaneous circulation) between different routes of epinephrine administration.
研究概览
简要总结
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.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
排除标准
- •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 .
研究组 & 干预措施
Intracoronary Epinephrine administration during cardiac arrest
干预措施: Epinephrin (Drug)
Peripheral intravenous Epinephrine administration during cardiac arrest
干预措施: Epinephrin (Drug)
Central intravenous Epinephrine administration during cardiac arrest
干预措施: Epinephrin (Drug)
结局指标
主要结局
ROSC (return of spontaneous circulation) between different routes of epinephrine administration.
时间窗: Up to 24 hours
Return of sinus rhythm or atrial fibrillation/flutter for more than 5 minutes (through ECG monitoring)
次要结局
- Survival to hospital discharge with favorable neurologic status (CPC score1-2)(Up to 30 days)
研究者
Ali Aldujeli
Cardiovascular disease consultant
Lithuanian University of Health Sciences