Cognition at Altitude in HEMS - Part II

NCT ID: NCT05073406

Last Updated: 2023-03-01

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

NA

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-09-01

Study Completion Date

2022-12-31

Brief Summary

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The aim of the current study is to evaluate under blinded conditions, both in a simulated environment and during helicopter flight, the effect of a rapid (within 20 minutes) exposure to altitude (4000 m asl) on physiological parameters and selected cognitive domains, in providers operating in helicopter emergency medical service (HEMS) exposed to hypobaric hypoxia or to hypobaric normoxia (H0: cognitive effects under hypobaric hypoxia = cognitive effects under hypobaric normoxia). Simulated environment will allow to control different factors. The parallelism between a study branch conducted in a simulated environment and another one conducted under a real-life condition will allow to evaluate the additive effects on additional stressor factors (processive and systemic ones).

* Simulation branch: each participant will take part in three research sessions: a familiarization session and two experimental sessions in simulation facility called terraXcube (test 1 and 2). On test 1 and test 2 each group will be exposed twice to the simulated altitude of 4000 m asl (under hypobaric hypoxia or hypobaric normoxia conditions) according to the randomization protocol. Participants will perform the neurocognitive tests three times on each of the two tests: before the ascent (TC0), after 5 min from the end of the ascent (TC1) and after around 30 min (TC2), to investigate European Union Aviation Safe Agency (EASA) proposed recommendations. After completing each neurocognitive test session, participants will be asked to rate their performance using a visual analogue scales (VAS). All participants will wear the vital parameters monitoring system during the entire duration of the tests inside the chamber, as well as the cerebral oxygen saturation (ScO2) sensor. Samples will be collected by saliva, urine and/or capillary blood. The same schedule is repeated in each test session.
* In-field branch: each participant will take part in three research sessions: a familiarization session and two experimental sessions during helicopter flights (test 1 and 2). On test 1 and test 2 each group will be exposed twice to the altitude of 4000 m (under hypobaric hypoxia or hypobaric normoxia conditions) according to the randomization protocol. Participants will perform the neurocognitive test two times on each test: before the ascent (TC0), after around 5 min from the end of the ascent (TC1). After completing each neurocognitive tests, participants will be asked to rate their performance using a visual analogue scales (VAS). All participants will wear the vital parameters monitoring system during the entire duration of the tests. Samples will be collected. The same schedule is planned in each test session.

Detailed Description

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Conditions

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Hypobaric Hypoxia Hypobaric Normoxia Cognitive Performance Emergency Medicine Stress Physiology

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Interventional, non-pharmacological, randomized, controlled, double-blinded, cross-over
Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Hypobaric normoxia

Altitude exposure in hypobaric normoxic condition

Group Type EXPERIMENTAL

Altitude exposure in hypobaric normoxic condition

Intervention Type OTHER

Altitude exposure with oxygen supplementation to achieve normoxia at altitude

Hypobaric hypoxia

Altitude exposure in hypobaric hypoxic condition

Group Type SHAM_COMPARATOR

Altitude exposure in hypobaric hypoxic condition

Intervention Type OTHER

Altitude exposure with air supplementation to obtain a sham comparator arm

Interventions

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Altitude exposure in hypobaric normoxic condition

Altitude exposure with oxygen supplementation to achieve normoxia at altitude

Intervention Type OTHER

Altitude exposure in hypobaric hypoxic condition

Altitude exposure with air supplementation to obtain a sham comparator arm

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* members of emergency medical services (EMS) and search and rescue (SAR) services with an occupational licence;
* an age between 18 and 60 years;
* an American Society of Anaesthesiologists (ASA) physical status class I;
* provided informed and written consent;
* no current COVID 19 symptoms and temperature ≤ 37.5°on test days, not being tested positive for COVID-19, ideally COVID-19 vaccinated.

Exclusion Criteria

* members under the age of 18 years;
* an ASA physical status class II or more;
* a medical history of psychiatric disorders and neurological diseases;
* previous high altitude pulmonary oedema (HAPE) or high altitude cerebral oedema (HACE) or severe acute mountain sickness (AMS) (defined as a Lake Louise Score (LLS) \> 9) occurred at altitudes similar to the ones tested in the study;
* no informed consent;
* current COVID 19 symptoms, being tested positive for COVID-19 or symptoms and body temperature ≥ 37.5°on test days.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University Grenoble Alps

OTHER

Sponsor Role collaborator

Università degli Studi di Trento

OTHER

Sponsor Role collaborator

Medical University Innsbruck

OTHER

Sponsor Role collaborator

Institute of Mountain Emergency Medicine

OTHER

Sponsor Role lead

Responsible Party

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Giacomo Strapazzon, MD PhD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Giacomo Strapazzon, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Eurac Research, Institute of Mountain Emergency Medicine

Marika Falla, MD PhD

Role: PRINCIPAL_INVESTIGATOR

University of Trento, Center for Mind/Brain Sciences - CIMeC

Michiel van Veelen, MD

Role: PRINCIPAL_INVESTIGATOR

Eurac Research, Institute of Mountain Emergency Medicine

Locations

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Eurac Research, Institute of Mountain Emergency Medicine

Bolzano, BZ, Italy

Site Status

Countries

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Italy

References

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Basner M, Moore TM, Nasrini J, Gur RC, Dinges DF. Standardization of psychomotor vigilance testing methods and reporting. Sleep. 2021 Jul 9;44(7):zsab114. doi: 10.1093/sleep/zsab114. No abstract available.

Reference Type BACKGROUND
PMID: 34019081 (View on PubMed)

Brodmann Maeder M, Brugger H, Pun M, Strapazzon G, Dal Cappello T, Maggiorini M, Hackett P, Bartsch P, Swenson ER, Zafren K. The STAR Data Reporting Guidelines for Clinical High Altitude Research. High Alt Med Biol. 2018 Mar;19(1):7-14. doi: 10.1089/ham.2017.0160. Epub 2018 Feb 9.

Reference Type BACKGROUND
PMID: 29596018 (View on PubMed)

Cable GG. In-flight hypoxia incidents in military aircraft: causes and implications for training. Aviat Space Environ Med. 2003 Feb;74(2):169-72.

Reference Type BACKGROUND
PMID: 12602449 (View on PubMed)

EASA. https://www.easa.europa.eu/document-library/notices-of-proposed-amendment/npa-2018-04. (2018).

Reference Type BACKGROUND

Falla M, Papagno C, Dal Cappello T, Vogele A, Hufner K, Kim J, Weiss EM, Weber B, Palma M, Mrakic-Sposta S, Brugger H, Strapazzon G. A Prospective Evaluation of the Acute Effects of High Altitude on Cognitive and Physiological Functions in Lowlanders. Front Physiol. 2021 Apr 28;12:670278. doi: 10.3389/fphys.2021.670278. eCollection 2021.

Reference Type BACKGROUND
PMID: 33995130 (View on PubMed)

Falla M, Hufner K, Falk M, Weiss EM, Vogele A, Jan van Veelen M, Weber B, Brandner J, Palma M, Dejaco A, Brugger H, Strapazzon G. Simulated Acute Hypobaric Hypoxia Effects on Cognition in Helicopter Emergency Medical Service Personnel - A Randomized, Controlled, Single-Blind, Crossover Trial. Hum Factors. 2024 Feb;66(2):404-423. doi: 10.1177/00187208221086407. Epub 2022 May 31.

Reference Type BACKGROUND
PMID: 35640630 (View on PubMed)

Hart, S., and Staveland, L. (1988). "Development of NASA-TLX (task load index) - results ofempirical and theoretical research," in HumanMental Workload, eds P. Hancock and N. Meshkati (Amsterdam: Springer), 139-183. doi: 10.1016/ s0166- 4115(08)62386- 9.

Reference Type BACKGROUND

Hinkelbein J, Glaser E. Evaluation of two oxygen face masks with special regard to inspiratory oxygen fraction (FiO2) for emergency use in rescue helicopters. Air Med J. 2008 Mar-Apr;27(2):86-90. doi: 10.1016/j.amj.2007.07.005.

Reference Type BACKGROUND
PMID: 18328973 (View on PubMed)

Mrakic-Sposta S, Vezzoli A, Malacrida S, Falla M, Strapazzon G. "Direct" and "Indirect" Methods to Detect Oxidative Stress During Acute or Chronic High-Altitude Exposure. High Alt Med Biol. 2017 Sep;18(3):303-304. doi: 10.1089/ham.2017.0067. Epub 2017 Jul 28. No abstract available.

Reference Type BACKGROUND
PMID: 28753037 (View on PubMed)

Nowacki J, Heekeren HR, Deuter CE, Joerissen JD, Schroder A, Otte C, Wingenfeld K. Decision making in response to physiological and combined physiological and psychosocial stress. Behav Neurosci. 2019 Feb;133(1):59-67. doi: 10.1037/bne0000288. Epub 2018 Dec 17.

Reference Type BACKGROUND
PMID: 30556701 (View on PubMed)

Wilson MH, Newman S, Imray CH. The cerebral effects of ascent to high altitudes. Lancet Neurol. 2009 Feb;8(2):175-91. doi: 10.1016/S1474-4422(09)70014-6.

Reference Type BACKGROUND
PMID: 19161909 (View on PubMed)

Falla M, van Veelen MJ, Falk M, Weiss EM, Roveri G, Mase M, Weber B, Randi A, Brugger H, Hufner K, Strapazzon G. Effect of oxygen supplementation on cognitive performance among HEMS providers after acute exposure to altitude: the HEMS II randomized clinical trial. Scand J Trauma Resusc Emerg Med. 2024 Jul 29;32(1):65. doi: 10.1186/s13049-024-01238-6.

Reference Type DERIVED
PMID: 39075543 (View on PubMed)

Other Identifiers

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98-2021

Identifier Type: -

Identifier Source: org_study_id

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