A Pilot Study Using Rocuronium to Prevent Intermediate Syndrome After Organophosphorus Insecticide Poisoning

NCT ID: NCT02147054

Last Updated: 2016-11-17

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

45 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-05-31

Study Completion Date

2016-07-31

Brief Summary

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Organophosphate pesticide poisoning causes close to 300 000 deaths per year worldwide. Many patients who ingest organophosphates require ventilation; of these patients approximately 50% die. Much of the mortality in these ventilated patients is secondary to intermediate syndrome. This is because OP pesticides inhibit acetylcholinesterase, causing an excess of acetylcholine at nerve synapses and the neuromuscular junction (NMJ). At the NMJ, the excess acetylcholine causes overstimulation and damage, which may lead to sudden respiratory arrest or prolonged ventilation and its associated complications.

The investigators believe that blocking these receptors using a neuromuscular blocking agent such as Rocuronium will protect the NMJ from damage and thus prevent intermediate syndrome and reduce number of intubated days and mortality.

In this pilot randomised controlled trial Rocuronium, a competitive nicotinic receptor antagonist, will be used to bind to the receptor at the neuromuscular junction and to block the effects of the accumulated acetylcholine. The effects of OP pesticide on cholinesterase in the blood will then be monitored and Rocuronium withdrawn using Sugammadex as the OP is eliminated from the body.

Detailed Description

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Primary outcome: Number of days intubated

Conditions

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Organophosphate Poisoning

Keywords

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Organophosphate poisoning Intermediate syndrome Rocuronium

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Rocuronium with >95% inhibition

IV Rocuronium to be given:

* Bolus dose of Rocuronium 0.3 mg/kg to achieve \>95% inhibition as indicated by Train of Four monitoring
* Continuous infusion of 1.5 mg/kg/hr to maintain level of inhibition
* To continue until two rises in butyrylcholinesterase seen or for a maximum of 5 days

Group Type ACTIVE_COMPARATOR

Rocuronium

Intervention Type DRUG

Sugammadex

Intervention Type DRUG

Effect of Rocuronium will be reversed at the appropriate time using Sugammadex 16mg/kg as a single dose which may be repeated once.

Rocuronium with 50% inhibition

IV Rocuronium to be given:

* Bolus dose of Rocuronium 0.3 mg/kg to achieve 50% inhibition as indicated by Train of Four monitoring
* Continuous infusion of 1.5 mg/kg/hr to maintain level of inhibition
* To continue until two rises in butyrylcholinesterase seen or for a maximum of 5 days

Group Type ACTIVE_COMPARATOR

Rocuronium

Intervention Type DRUG

Sugammadex

Intervention Type DRUG

Effect of Rocuronium will be reversed at the appropriate time using Sugammadex 16mg/kg as a single dose which may be repeated once.

No Rocuronium

No Rocuronium will be given

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Rocuronium

Intervention Type DRUG

Sugammadex

Effect of Rocuronium will be reversed at the appropriate time using Sugammadex 16mg/kg as a single dose which may be repeated once.

Intervention Type DRUG

Other Intervention Names

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Esmeron Bridion

Eligibility Criteria

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Inclusion Criteria

* Male or female
* Age over 16
* Clinical diagnosis of OP insecticide poisoning
* Admission to Intensive Care Unit for Ventilation
* Informed consent from family
* Train of four measurement \> 50%

Exclusion Criteria

* Age 16 or under
* Pregnant
* Consent not obtained from patient or patient's family
Minimum Eligible Age

17 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Peradeniya

OTHER

Sponsor Role collaborator

University of Edinburgh

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Indika Gawarammana, MD FRCPE PhD

Role: PRINCIPAL_INVESTIGATOR

South Asian Clinical Toxicology Research Collaboration

Michael Eddleston, MA PhD FRCP

Role: STUDY_DIRECTOR

University of Edinburgh

Vasanti Pinto, MD FRCA FCARSCI

Role: STUDY_DIRECTOR

University of Peradeniya

Vajira Weerasinghe, BDS MPhil PhD

Role: STUDY_DIRECTOR

University of Peradeniya

Locations

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Peradeniya Teaching Hospital

Peradeniya, Central Province, Sri Lanka

Site Status

Countries

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Sri Lanka

Other Identifiers

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Rocuronium Pilot May 14

Identifier Type: -

Identifier Source: org_study_id