Intravenous Magnesium Sulfate in Aneurysmal Subarachnoid Haemorrhage (IMASH)

NCT ID: NCT00124150

Last Updated: 2009-12-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

327 participants

Study Classification

INTERVENTIONAL

Study Start Date

2002-06-30

Study Completion Date

2009-06-30

Brief Summary

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The IMASH trial is a simple, randomized, double-blinded, placebo-controlled, multi-center trial to answer the question: "Does intravenous magnesium sulfate improve clinical outcome after aneurysmal subarachnoid hemorrhage?"

Detailed Description

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Vasospasm worsen outcome in patients with aneurysmal subarachnoid hemorrhage (ASAH).

Magnesium is known to dilate cerebral arteries and to block N-methyl-D-aspartate receptors in the injured neurons.

Intravenous magnesium may prevent vasospasm after subarachnoid hemorrhage and may protect neurons against damage during established vasospasm.

The IMASH trial is a randomized, placebo-controlled, double-blinded, multi-center trial to evaluate the effect that intravenous magnesium sulfate infusion on the clinical outcome of patients with aneurysmal subarachnoid haemorrhage.

Methods:

After obtaining randomisation code:

* Start MgSO4 20 mmol over 30 minutes, followed by infusion of 80 mmol/day or equivalent volume of saline within 48 h after onset of symptom,
* Study drug to be infused for 14 days from the day of hemorrhage (regarded as day 0).
* Measure plasma magnesium concentration daily and perform transcranial Doppler to monitor blood flow velocities of both middle cerebral arteries and extracranial segment of the internal carotid arteries.
* Plasma magnesium concentration in the IV MgSO4 group should be raised to 2.0-2.5 mmol/L or twice the serum baseline level. Patients that are randomized to saline infusion will only have their magnesium levels normalized if there is a clinical indication to do so.

Outcome assessment Primary outcome: Extended Glasgow Outcome Scale at six months Secondary outcome: Incidence of clinical vasospasm, Barthel Index; modified Rankin score, modified National Institute of Health Stroke Score, MCA velocities, other major complications

Study duration:

6 years with a refined sample size of 340 after analysis of pilot study data; with planned interim analysis.

Conditions

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Subarachnoid Hemorrhage

Keywords

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subarachnoid hemorrhage magnesium sulfate

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

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M

Intravenous magnesium sulfate infusion for 14 days.

Group Type EXPERIMENTAL

Intravenous magnesium sulfate infusion

Intervention Type DRUG

80mg per day

S

Saline infusion without additional magnesium sulfate.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Intravenous magnesium sulfate infusion

80mg per day

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* ASAH (as indicated by CT scan or lumbar puncture and an intracranial aneurysm confirmed by computer tomographic or conventional angiography)
* Within 48 hrs of ictus (hemorrhage event)

Exclusion Criteria

* Pregnancy
* Major renal, hepatic or pulmonary disease
* Major cardiac disease or recent myocardial infarct (\< 6 months)
* Age less than 18 years
* Moribund condition on admission (defined as a patient that is in such a poor clinical condition that further active neurosurgical management would not be anticipated)
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Chinese University of Hong Kong

OTHER

Sponsor Role lead

Responsible Party

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Division of Neurosurgery, The Chinese University of Hong Kong

Principal Investigators

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Wai S Poon, MB ChB FRCS

Role: PRINCIPAL_INVESTIGATOR

Department of Surgery, The Chinese University of Hong Kong

Locations

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Department of Surgery, The Chinese University of Hong Kong

Hong Kong, , China

Site Status

Countries

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China

References

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Boet R, Mee E. Magnesium sulfate in the management of patients with Fisher Grade 3 subarachnoid hemorrhage: a pilot study. Neurosurgery. 2000 Sep;47(3):602-6; discussion 606-7. doi: 10.1097/00006123-200009000-00014.

Reference Type BACKGROUND
PMID: 10981747 (View on PubMed)

Boet R, Poon WS, Chan MT. Re: Magnesium: a useful adjunct in the prevention of cerebral vasospasm following aneurysmal subarachnoid haemorrhage. J Clin Neurosci. 2003 May;10(3):394. doi: 10.1016/s0967-5868(03)00006-7. No abstract available.

Reference Type BACKGROUND
PMID: 12763359 (View on PubMed)

Wong GK, Poon WS, Chan MT, Boet R, Gin T, Lam CW. The effect of intravenous magnesium sulfate infusion on serum levels of sodium and potassium in patients with aneurysmal subarachnoid hemorrhage. Magnes Res. 2007 Mar;20(1):37-42.

Reference Type BACKGROUND
PMID: 17536487 (View on PubMed)

Boet R, Chan MT, Poon WS, Wong GK, Wong HT, Gin T. Intravenous magnesium sulfate to improve outcome after aneurysmal subarachnoid hemorrhage: interim report from a pilot study. Acta Neurochir Suppl. 2005;95:263-4. doi: 10.1007/3-211-32318-x_53.

Reference Type RESULT
PMID: 16463861 (View on PubMed)

Wong GK, Chan MT, Boet R, Poon WS, Gin T. Intravenous magnesium sulfate after aneurysmal subarachnoid hemorrhage: a prospective randomized pilot study. J Neurosurg Anesthesiol. 2006 Apr;18(2):142-8. doi: 10.1097/00008506-200604000-00009.

Reference Type RESULT
PMID: 16628069 (View on PubMed)

Wong GK, Chan MT, Poon WS, Boet R, Gin T. Magnesium therapy within 48 hours of an aneurysmal subarachnoid hemorrhage: neuro-panacea. Neurol Res. 2006 Jun;28(4):431-5. doi: 10.1179/016164106X115035.

Reference Type RESULT
PMID: 16759446 (View on PubMed)

Wong GK, Chan MT, Boet R, Poon WS. Correspondence to 'dose evaluation for long-term magnesium treatment in aneurysmal subarachnoid haemorrhage'. J Clin Pharm Ther. 2006 Aug;31(4):407. doi: 10.1111/j.1365-2710.2006.00728.x. No abstract available.

Reference Type RESULT
PMID: 16882114 (View on PubMed)

Wong GK, Poon WS. Clinical, transcranial Doppler ultrasound, radiological features and, prognostic significance of delayed cerebral ischemia. Acta Neurochir Suppl. 2013;115:9-11. doi: 10.1007/978-3-7091-1192-5_3.

Reference Type DERIVED
PMID: 22890635 (View on PubMed)

Wong GK, Poon WS, Boet R, Chan MT, Gin T, Ng SC, Zee BC. Health-related quality of life after aneurysmal subarachnoid hemorrhage: profile and clinical factors. Neurosurgery. 2011 Jun;68(6):1556-61; discussion 1561. doi: 10.1227/NEU.0b013e31820cd40d.

Reference Type DERIVED
PMID: 21311383 (View on PubMed)

Wong GK, Poon WS, Chan MT, Boet R, Gin T, Ng SC, Zee BC; IMASH Investigators. Intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage (IMASH): a randomized, double-blinded, placebo-controlled, multicenter phase III trial. Stroke. 2010 May;41(5):921-6. doi: 10.1161/STROKEAHA.109.571125. Epub 2010 Apr 8.

Reference Type DERIVED
PMID: 20378868 (View on PubMed)

Other Identifiers

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IMASH trial

Identifier Type: -

Identifier Source: org_study_id