Clinical Trial of Normobaric Oxygen Therapy in Acute Ischemic Stroke
Overview
- Phase
- Phase 2
- Intervention
- NBO (Normobaric Oxygen)
- Conditions
- Ischemic Stroke
- Sponsor
- Massachusetts General Hospital
- Enrollment
- 85
- Locations
- 2
- Primary Endpoint
- Primary Safety Outcome Measure is a Comparison of the Change in National Institutes of Health Stroke Scale (NIHSS) Scores From Baseline to 24 Hours (After Therapy) in the Two Groups.
- Status
- Terminated
- Last Updated
- 8 years ago
Overview
Brief Summary
The purpose of this study is to compare the safety and efficacy of treating individuals with acute ischemic stroke with normobaric oxygen therapy (NBO, given within 9 hours of symptom onset), to standard medical treatment.
Detailed Description
Stroke is the third leading cause of death and the leading cause of disability in the United States. Ischemic stroke is caused by a blockage of blood flow to one or more brain arteries, usually due to a blood clot. As a result there is a reduced supply of oxygen and other nutrients leading to permanent brain damage. Normobaric oxygen therapy (NBO, or high-flow oxygen delivered via a facemask) shows promise as a simple, widely accessible, low-cost therapy that can prevent stroke-related brain damage and extend the time window for administering the clot-busting drug t-PA (tissue plasminogen activator), which is the only acute stroke treatment approved by the Food and Drug Administration. The primary goal of this trial is to compare the safety and therapeutic efficacy of NBO (started within 9 hours of symptom onset) to standard medical treatment with Room Air. We aim to enroll a total of 240 individuals with acute ischemic stroke less than 9 hours after symptom onset, at the Massachusetts General and Brigham and Women's Hospitals in Boston. Participants will be randomly selected to receive either room air (RA, control) or NBO (active treatment) at flow rates of 30-45L/min administered via a face mask for 8 hours. Neurological function scores and neuroimaging \[magnetic resonance imaging (MRI) or computed tomography (CT) scans\] will be obtained before, during, and after therapy until 90 days. This study is part of the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS), which allows researchers to enhance and initiate translational research that ultimately will benefit individuals with stroke.
Investigators
Aneesh B. Singhal, MD
Associate Professor of Neurology
Massachusetts General Hospital
Eligibility Criteria
Inclusion Criteria
- •Age greater than or equal to 18 years.
- •Acute ischemic stroke in whom treatment can potentially be started within 9 hours after symptom onset. If the symptom onset time is unknown, the time of onset will be defined as the midpoint between the time when the subject was last seen neurologically intact, and when found to have a neurological deficit.
- •National Institutes of Health Stroke Scale (NIHSS) score 4 or greater.
Exclusion Criteria
- •Patients being actively considered for intravenous or intra-arterial thrombolysis will be excluded.
- •Patients likely to have acute stroke intervention such as carotid endarterectomy or stent or angioplasty, hemicraniectomy, etc.
- •Rapidly improving neurological deficits (transient ischemic attack).
- •Known history of severe chronic obstructive pulmonary disease (Forced Expiratory Vital Capacity less than 1.0 or oxygen dependent).
- •More than 3 L/min oxygen required to maintain peripheral arterial oxygen saturation above 92%.
- •New York Heart Association Class III heart failure.
- •Endotracheal intubation prior to enrollment or impending need for artificial ventilation.
- •Coma (National Institutes of Health Stroke Scale item 1a score of 3).
- •Suspected seizure at or after onset of stroke, or a known active seizure disorder.
- •Blood glucose below 50 mg/dL or greater than 250 mg/dL prior to enrollment.
Arms & Interventions
NBO (Normobaric Oxygen)
Oxygen, inhaled at 30-45L/min via a facemask for 8 hours
Intervention: NBO (Normobaric Oxygen)
NBO (Normobaric Oxygen)
Oxygen, inhaled at 30-45L/min via a facemask for 8 hours
Intervention: Room Air
Room Air
Room Air, inhaled at 30-45L/min via a facemask for 8 hours
Intervention: NBO (Normobaric Oxygen)
Room Air
Room Air, inhaled at 30-45L/min via a facemask for 8 hours
Intervention: Room Air
Outcomes
Primary Outcomes
Primary Safety Outcome Measure is a Comparison of the Change in National Institutes of Health Stroke Scale (NIHSS) Scores From Baseline to 24 Hours (After Therapy) in the Two Groups.
Time Frame: 24 hours
The NIHSS score ranges from 0 (best score) to 42 (worst score).
Primary Efficacy Outcome Measure is a Comparison of the Change in National Institutes of Health Stroke Scale (NIHSS) Scores From Baseline to 4 Hours (During Therapy) in the Two Groups.
Time Frame: 4 hours after starting treatment
The NIHSS score ranges from 0 (best score) to 42 (worst score).