Vasopressin in Traumatic Hemorrhagic Shock Study

NCT ID: NCT00379522

Last Updated: 2014-11-05

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

PHASE2/PHASE3

Total Enrollment

64 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-07-31

Study Completion Date

2014-10-31

Brief Summary

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The purpose of the present trial is therefore to assess effects of arginine vasopressin vs. saline placebo on hospital admission rate (primary end point), as well as hemodynamic variables, fluid resuscitation requirements and hospital discharge rate (secondary study end points) in presumed traumatic hemorrhagic shock patients with a systolic arterial blood pressure \<90 mm Hg after 10 min of standard shock treatment. Accordingly, the study reflects an add-on design to standard traumatic shock therapy.

The hypothesis is that both arginine vasopressin and saline placebo have comparable effects on hemodynamic variables, fluid resuscitation requirements, and hospital admission and discharge rate. The alternative hypothesis is that arginine vasopressin has more beneficial effects on hemodynamic variables, fluid resuscitation requirements, and hospital admission and discharge rate than saline placebo.

Detailed Description

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The study will be designed as a multicenter, randomized, placebo-controlled clinical trial with blinded assessment of the outcome in a study network with helicopter emergency medical service units in Austria, Germany, Switzerland, Italy, Czech Republic and the Netherlands.

The protocol, information and consent procedure will be approved by the institutional review board of each participating center. Since this is a study randomizing unconscious patients who are unable to give informed consent at the time of randomization (§43a Emergency study), the requirement of informed consent is planned to be waived in accordance with the ethical standards of national legislation in Germany, Austria, Switzerland, Italy, Czech Republic and the Netherlands and the guidelines for good clinical practice of the European Agency for the Evaluation of Medicinal products. Depending on the patient's outcome, either the surviving patient, or the patient's family in case of death of the patient or in case that the patient survives but remains mentally handicapped will be informed about the trial (see appendix for patient information sheet); the protocol specifies that if there are any objections, the patient will be withdrawn from the study.

Treatment assignments of blinded study drugs will be randomly generated by computer in blocks of two, with stratification according to center. Before the start of the trial, staff at participating centers will be informed about the rationale of the protocol and the study; participating centers will be subsequently contacted and visited to ensure proper enrollment.

Conditions

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Shock Hypovolemia Hemorrhagic Shock

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Vasopressin

Vasopressin, 10 I.U./4 ml, Solution for Injection

Group Type ACTIVE_COMPARATOR

Vasopressin

Intervention Type DRUG

10 minutes after standard shock treatment 10 IU arginine vasopressin will be injected; if shock persists for 5 minutes, another 10 IU arginine vasopressin will be injected; after 5 minutes persisting shock, the last 10 IU arginine vasopressin will be injected; Total duration: approx. 15 minutes; Dose per intravenous injection: 10 IU; max. dose: 30 IU arginine vasopressin

Saline

Saline placebo 4 ml, Solution for Injection

Group Type PLACEBO_COMPARATOR

Saline placebo

Intervention Type DRUG

Placebo for arginine vasopressin

Interventions

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Vasopressin

10 minutes after standard shock treatment 10 IU arginine vasopressin will be injected; if shock persists for 5 minutes, another 10 IU arginine vasopressin will be injected; after 5 minutes persisting shock, the last 10 IU arginine vasopressin will be injected; Total duration: approx. 15 minutes; Dose per intravenous injection: 10 IU; max. dose: 30 IU arginine vasopressin

Intervention Type DRUG

Saline placebo

Placebo for arginine vasopressin

Intervention Type DRUG

Other Intervention Names

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Pressyn CPREssin Pitressin Kochsalz Saline

Eligibility Criteria

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Inclusion Criteria

* Adult trauma patients presenting with presumed traumatic hemorrhagic shock (systolic arterial blood pressure \<90 mm Hg) that does not respond to the first 10 min of standard shock treatment \[endotracheal intubation, crystalloid-, colloid-, and hypertonic saline (up to 4 ml/kg) fluid resuscitation, and catecholamine (ephedrine, phenylephrine, norepinephrine, epinephrine) vasopressors\].

Exclusion Criteria

* Terminal illness
* No intravenous access
* Age \< 18 years
* Injury \> 60 min before randomization
* Known pregnancy
* Cardiac arrest before randomization
* Presence of a do-not-resuscitate order
* Untreated tension pneumothorax
* Untreated cardiac tamponade
* Participation in another clinical study.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Volker Wenzel

OTHER

Sponsor Role lead

Responsible Party

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Volker Wenzel

Prof. Dr.

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Prof. Dr. Volker Wenzel, M.Sc., M.D.

Role: STUDY_CHAIR

Innsbruck Medical University, Dep. for Anaesthesia and Crit. Care Management

Locations

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HEMS Ybbsitz / Hospital Amstetten

Amstetten, Lower Austria, Austria

Site Status

Hospital Krems

Krems, Lower Austria, Austria

Site Status

Hospital Wiener Neustadt

Wiener Neustadt, Lower Austria, Austria

Site Status

Hospital Salzburg

Salzburg, Salzburg, Austria

Site Status

Medical University of Graz

Graz, Styria, Austria

Site Status

Medical University of Innsbruck

Innsbruck, Tyrol, Austria

Site Status

Hospital Linz

Linz, Upper Austria, Austria

Site Status

HEMS Suben / Landeskrankenhaus Schärding

Schärding, Upper Austria, Austria

Site Status

University Hospital of Dresden

Dresden, , Germany

Site Status

University Hospital of Goettingen

Göttingen, , Germany

Site Status

University Hospital of Mannheim

Mannheim, , Germany

Site Status

BG-Unfallklinik Murnau

Murnau am Staffelsee, , Germany

Site Status

Ev. Jung-Stilling-Krankenhaus

Siegen, , Germany

Site Status

Bundeswehrkrankenhaus Ulm

Ulm, , Germany

Site Status

Countries

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Austria Germany

References

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Krismer AC, Wenzel V, Voelckel WG, Innerhofer P, Stadlbauer KH, Haas T, Pavlic M, Sparr HJ, Lindner KH, Koenigsrainer A. Employing vasopressin as an adjunct vasopressor in uncontrolled traumatic hemorrhagic shock. Three cases and a brief analysis of the literature. Anaesthesist. 2005 Mar;54(3):220-4. doi: 10.1007/s00101-004-0793-y.

Reference Type BACKGROUND
PMID: 15605286 (View on PubMed)

Schummer W, Schummer C, Fuchs J. [Vasopressin]. Anaesthesist. 2005 Jul;54(7):707-8. doi: 10.1007/s00101-005-0854-x. No abstract available. German.

Reference Type BACKGROUND
PMID: 15843908 (View on PubMed)

Tsuneyoshi I, Onomoto M, Yonetani A, Kanmura Y. Low-dose vasopressin infusion in patients with severe vasodilatory hypotension after prolonged hemorrhage during general anesthesia. J Anesth. 2005;19(2):170-3. doi: 10.1007/s00540-004-0299-4.

Reference Type BACKGROUND
PMID: 15875138 (View on PubMed)

Raedler C, Voelckel WG, Wenzel V, Krismer AC, Schmittinger CA, Herff H, Mayr VD, Stadlbauer KH, Lindner KH, Konigsrainer A. Treatment of uncontrolled hemorrhagic shock after liver trauma: fatal effects of fluid resuscitation versus improved outcome after vasopressin. Anesth Analg. 2004 Jun;98(6):1759-1766. doi: 10.1213/01.ANE.0000117150.29361.5A.

Reference Type BACKGROUND
PMID: 15155342 (View on PubMed)

Stadlbauer KH, Wenzel V, Krismer AC, Voelckel WG, Lindner KH. Vasopressin during uncontrolled hemorrhagic shock: less bleeding below the diaphragm, more perfusion above. Anesth Analg. 2005 Sep;101(3):830-832. doi: 10.1213/01.ANE.0000175217.55775.1C. No abstract available.

Reference Type BACKGROUND
PMID: 16115999 (View on PubMed)

Stadlbauer KH, Wagner-Berger HG, Raedler C, Voelckel WG, Wenzel V, Krismer AC, Klima G, Rheinberger K, Nussbaumer W, Pressmar D, Lindner KH, Konigsrainer A. Vasopressin, but not fluid resuscitation, enhances survival in a liver trauma model with uncontrolled and otherwise lethal hemorrhagic shock in pigs. Anesthesiology. 2003 Mar;98(3):699-704. doi: 10.1097/00000542-200303000-00018.

Reference Type BACKGROUND
PMID: 12606914 (View on PubMed)

Voelckel WG, Raedler C, Wenzel V, Lindner KH, Krismer AC, Schmittinger CA, Herff H, Rheinberger K, Konigsrainer A. Arginine vasopressin, but not epinephrine, improves survival in uncontrolled hemorrhagic shock after liver trauma in pigs. Crit Care Med. 2003 Apr;31(4):1160-5. doi: 10.1097/01.CCM.0000060014.75282.69.

Reference Type BACKGROUND
PMID: 12682488 (View on PubMed)

O'Callaghan DJ, Gordon AC. What's new in vasopressin? Intensive Care Med. 2015 Dec;41(12):2177-9. doi: 10.1007/s00134-015-3849-3. Epub 2015 May 7. No abstract available.

Reference Type DERIVED
PMID: 25947955 (View on PubMed)

Related Links

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http://www.vitris.at

Study Homepage

Other Identifiers

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Vitris

Identifier Type: -

Identifier Source: org_study_id

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