Impact of Intracoronary Versus Intravenous Epinephrine Administration During Cardiac Arrest .

NCT05253937 | Completed DMC

• 1 other identifier: LUHSKC-175
• Study Type: observational
• Target: 160
• Locations: 1 country
• Sites: 1

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.

Conditions

Cardiopulmonary Arrest; Epinephrine Causing Adverse Effects in Therapeutic Use

Outcome Measures

Primary Outcomes (1)

• ROSC (return of spontaneous circulation) between different routes of epinephrine administration.

  Return of sinus rhythm or atrial fibrillation/flutter for more than 5 minutes (through ECG monitoring)

  Up to 24 hours

Secondary Outcomes (1)

• Survival to hospital discharge with favorable neurologic status (CPC score1-2)

  Up to 30 days

Other Outcomes (1)

• inhospital stent thrombosis

  Up to 30 days

Study Arms (3)

Intracoronary Epinephrine administration during cardiac arrest

Drug: Epinephrin

Peripheral intravenous Epinephrine administration during cardiac arrest

Drug: Epinephrin

Central intravenous Epinephrine administration during cardiac arrest

Drug: Epinephrin

Interventions

Epinephrin DRUG

The study will enroll acute myocardial infarction patients who suffered from a cardiac arrest in the cardiac catheterization laboratory during percutaneous intervention procedure. Cardiac Resuscitation was performed according to the European Resuscitation Council (ERC) Guidelines. The preferred route of epinephrine administration was through the central venous access (by internal jugular or subclavian vein). Thus, if available, it was the preferred method of medication delivery. However, in cases without central venous access, the route of epinephrine administration (peripheral intravenous or arterial intracoronary) during cardiac arrest was left to the treating physicians.

Central intravenous Epinephrine administration during cardiac arrest; Intracoronary Epinephrine administration during cardiac arrest; Peripheral intravenous Epinephrine administration during cardiac arrest

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

This is a prospective, cohort, dual center pilot study, conducted in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics and the Republican Hospital of Panevezys from 2018 to 2022. Both cardiac centers covers six out of ten administrative regions in the republic of Lithuania.

You may qualify if:

• 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

You may not qualify if:

• 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 .

Sponsors & Collaborators

• Lithuanian University of Health Sciences: lead
• Baylor Scott and White Health: collaborator
• Minneapolis Heart Institute: collaborator

Study Sites (1)

Ali Aldujeli

Kaunas, LT-50161, Lithuania

Location

Related Publications (1)

• Aldujeli A, Haq A, Tecson KM, Kurnickaite Z, Lickunas K, Bailey S, Tatarunas V, Braukyliene R, Baksyte G, Aldujeili M, Khalifeh H, Briedis K, Ordiene R, Unikas R, Hamadeh A, Brilakis ES. A prospective observational study on impact of epinephrine administration route on acute myocardial infarction patients with cardiac arrest in the catheterization laboratory (iCPR study). Crit Care. 2022 Dec 20;26(1):393. doi: 10.1186/s13054-022-04275-8.

  PMID: 36539907 DERIVED

MeSH Terms

Conditions

Heart Arrest

Interventions

Epinephrine

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases

Intervention Hierarchy (Ancestors)

Ethanolamines; Amino Alcohols; Alcohols; Organic Chemicals; Amines; Biogenic Monoamines; Biogenic Amines; Catecholamines; Catechols; Phenols; Benzene Derivatives; Hydrocarbons, Aromatic; Hydrocarbons, Cyclic; Hydrocarbons

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Cardiovascular disease consultant

Study Record Dates

• First Submitted: January 23, 2022
• First Posted: February 24, 2022
• Study Start: April 1, 2018
• Primary Completion: June 1, 2021
• Study Completion: June 1, 2022
• Last Updated: August 16, 2022

Record last verified: 2022-08

Locations

LI (1)