Impact of Intracoronary Versus Intravenous Epinephrine Administration During Cardiac Arrest .

NCT ID: NCT05253937

Last Updated: 2022-08-16

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 160 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2018-04-01
• Study Completion Date: 2022-06-01

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

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Intracoronary Epinephrine administration during cardiac arrest

Epinephrin

Intervention Type: 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.

Peripheral intravenous Epinephrine administration during cardiac arrest

Epinephrin

Intervention Type: 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

Epinephrin

Intervention Type: 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.

Interventions

Epinephrin

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.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• 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

Exclusion Criteria

• 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 .

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Baylor Scott and White Health

OTHER

Sponsor Role: collaborator

Minneapolis Heart Institute

OTHER

Sponsor Role: collaborator

Lithuanian University of Health Sciences

OTHER

Sponsor Role: lead

Responsible Party

Ali Aldujeli

Cardiovascular disease consultant

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Ali Aldujeli

Kaunas, , Lithuania

Countries

Lithuania

References

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.

Reference Type: DERIVED

PMID: 36539907 (View on PubMed)

Other Identifiers

LUHSKC-175

Identifier Type: -

Identifier Source: org_study_id