Early Amiodarone in Shockable Cardiac Arrest

NCT ID: NCT06680869

Last Updated: 2025-12-19

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

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

585 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-01-01

Study Completion Date

2028-01-31

Brief Summary

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The primary objective of this pilot, pragmatic stepped-wedge cluster randomized trial is to evaluate if a modified cardiac arrest treatment algorithm calling for the administration of the initial amiodarone dose one 2-minute cycle earlier than current guidelines (during the same cycle as the initial dose of epinephrine) improves the time to amiodarone delivery in those with out-of-hospital cardiac arrest due to refractory ventricular fibrillation or ventricular tachycardia compared to usual care.

Detailed Description

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The primary objective of this pilot, pragmatic stepped-wedge cluster randomized trial is to evaluate if a modified cardiac arrest treatment algorithm calling for the administration of the initial amiodarone dose one 2-minute cycle earlier than current guidelines (during the same cycle as the initial dose of epinephrine) improves the time to amiodarone delivery in those with out-of-hospital cardiac arrest due to refractory ventricular fibrillation or ventricular tachycardia compared to usual care.

The null hypothesis is that there is no difference in time to amiodarone delivery, relative to emergency medical services (EMS) arrival on-scene or time of arrest if witnessed by EMS, in the modified protocol calling for earlier amiodarone administration compared to usual care.

Evaluated secondary outcomes will include the proportion of patients receiving amiodarone before their third defibrillation, pulses present at emergency department arrival, survival to hospital discharge, neurologically intact survival at hospital discharge, timing to other critical EMS interventions, and clinical adverse events.

Conditions

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Cardiac Arrest

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Early Amiodarone Protocol

Amiodarone administration after the second defibrillator shock, during the same two-minute cycle as the initial dose of epinephrine.

Group Type EXPERIMENTAL

Amiodarone Hydrochloride Injection

Intervention Type DRUG

The use of a modified treatment protocol by emergency medical services where the initial dose of amiodarone is given after the second defibrillator shock, during the same two-minute cycle as the initial dose of epinephrine, for out-of-hospital cardiac arrest due to a shockable rhythm (ventricular fibrillation or ventricular tachycardia) that is persistent or recurs after at least one defibrillation attempt.

If an EMS agency is assigned to this arm, no downstream care after the initial dose of amiodarone is dictated by the study.

Usual Care Protocol

Amiodarone administration after the third defibrillator shock, one two-minute cycle after the initial dose of epinephrine.

Group Type ACTIVE_COMPARATOR

Usual Care Protocol

Intervention Type OTHER

The use of a usual care treatment protocol by emergency medical services where the initial dose of amiodarone is given after the third defibrillator shock, one two-minute cycle after the initial dose of epinephrine, for out-of-hospital cardiac arrest due to a shockable rhythm (ventricular fibrillation or ventricular tachycardia) that is persistent or recurs after at least one defibrillation attempt.

If an EMS agency is assigned to this arm, no downstream care after the initial dose of amiodarone is dictated by the study.

Interventions

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Amiodarone Hydrochloride Injection

The use of a modified treatment protocol by emergency medical services where the initial dose of amiodarone is given after the second defibrillator shock, during the same two-minute cycle as the initial dose of epinephrine, for out-of-hospital cardiac arrest due to a shockable rhythm (ventricular fibrillation or ventricular tachycardia) that is persistent or recurs after at least one defibrillation attempt.

If an EMS agency is assigned to this arm, no downstream care after the initial dose of amiodarone is dictated by the study.

Intervention Type DRUG

Usual Care Protocol

The use of a usual care treatment protocol by emergency medical services where the initial dose of amiodarone is given after the third defibrillator shock, one two-minute cycle after the initial dose of epinephrine, for out-of-hospital cardiac arrest due to a shockable rhythm (ventricular fibrillation or ventricular tachycardia) that is persistent or recurs after at least one defibrillation attempt.

If an EMS agency is assigned to this arm, no downstream care after the initial dose of amiodarone is dictated by the study.

Intervention Type OTHER

Other Intervention Names

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Early-Amiodarone Protocol

Eligibility Criteria

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Inclusion Criteria

* Emergency medical services (EMS)-treated non-traumatic out-of-hospital cardiac arrest
* Initial rhythm on EMS rhythm assessment of ventricular fibrillation or ventricular tachycardia
* Recurrence or persistence of ventricular fibrillation or ventricular tachycardia after one defibrillation attempt

Exclusion Criteria

* Known allergy to amiodarone
* EMS-assessed contraindication to amiodarone
* Pre-existing "do-not-attempt-resuscitation" orders
* Inter-facility transportations
* Initial care by a non-participating EMS agency able to perform advanced life support interventions
* Pediatric patient as determined by EMS
* Prisoners
* Pregnant patients
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

Oregon Health and Science University

OTHER

Sponsor Role lead

Responsible Party

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Joshua Lupton

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Joshua Lupton, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Oregon Health and Science University

Locations

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Oregon Health & Sciences University

Portland, Oregon, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Joshua Lupton, MD, MPH

Role: CONTACT

Phone: (503) 418-6706

Email: [email protected]

Facility Contacts

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Joshua Lupton, MD, MPH

Role: primary

Related Links

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Other Identifiers

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1K23HL173647-01

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY00026455

Identifier Type: -

Identifier Source: org_study_id