Emergency Preservation and Resuscitation (EPR) for Cardiac Arrest From Trauma (EPR-CAT)

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Emergency Preservation and Resuscitation (EPR) for Cardiac Arrest From Trauma (EPR-CAT)

This study is not yet open for participant recruitment.
Verified by University of Pittsburgh, January 2010
First Received: January 4, 2010 No Changes Posted
Sponsor: University of Pittsburgh
Collaborators: University of Maryland
University of Pennsylvania
Massachusetts General Hospital
University of Arizona
Oregon Health and Science University
Information provided by: University of Pittsburgh
ClinicalTrials.gov Identifier: NCT01042015
Purpose
The goal of this study is to rapidly cool trauma victims who have suffered cardiac arrest from bleeding with a flush of ice-cold sodium chloride to preserve the patient to enable surgical control of bleeding, followed by delayed resuscitation with cardiopulmonary bypass.


Condition Intervention Phase
Cardiac Arrest From Trauma
Other: Emergency preservation and resuscitation
Other: Standard resuscitation
Phase II

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Control: Active Control
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Emergency Preservation and Resuscitation for Cardiac Arrest From Trauma

Resource links provided by NLM:

MedlinePlus related topics: Injuries Wounds
U.S. FDA Resources

Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
The primary endpoint is survival to hospital discharge without major disability (Glasgow Outcome Scale-Extended >5). [ Time Frame: Hospital discharge ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
Feasibility of initiating EPR (cooling and achieving goal brain temperature) [ Time Frame: 1 hour ] [ Designated as safety issue: Yes ]
Survival [ Time Frame: 28 days ] [ Designated as safety issue: No ]
Neurologic functional outcome [ Time Frame: 6 months ] [ Designated as safety issue: No ]
Multiple organ system dysfunction [ Time Frame: During the initial hospitalization ] [ Designated as safety issue: No ]

Estimated Enrollment: 20
Arms Assigned Interventions
Concurrent controls: Active Comparator
These subjects would undergo standard resuscitative efforts.
Other: Standard resuscitation
Standard resuscitation includes an emergency department thoracotomy, open cardiac massage, and fluid resuscitation.
Emergency preservation and resuscitation: Experimental
These subjects would undergo the complete EPR protocol, including rapid induction of hypothermia, resuscitative surgery, and resuscitation with cardiopulmonary bypass.
Other: Emergency preservation and resuscitation
This involves the induction of profound hypothermia using a flush of ice-cold saline into the aorta. Once hypothermia is achieved, the subject would undergo rapid operative interventions to control bleeding followed by resuscitation/rewarming with cardiopulmonary bypass.

Detailed Description:
The intent of the technique to be studied is to induce a state of hypothermic preservation in trauma victims who have exsanguinated to the point of cardiac arrest. In appropriately selected subjects, after an initial emergency attempt at resuscitation with standard techniques, an arterial catheter will be inserted into the descending thoracic aorta. Using appropriate tubing, pump, and heat exchanger,a large quantity of ice-cold saline (0.9% Sodium Chloride for Injection USP) will be pumped as rapidly as possible into the aorta with the goal of cooling the brain (tympanic membrane temperature, Tty) to <10 C. If possible, a large venous catheter will be placed and recirculation of fluid established.

Once the subject has been sufficiently cooled, bleeding will be controlled surgically. The subject will then be resuscitated and rewarmed with full cardiopulmonary bypass.

The goal is to improve neurologically-intact survival in these patients.

Eligibility

Ages Eligible for Study: 18 Years to 65 Years
Genders Eligible for Study: Both
Accepts Healthy Volunteers: No
Criteria
Inclusion Criteria:

Blunt or penetrating trauma with clinical suspicion of exsanguinating hemorrhage
At least 1 sign of life at the scene (pulse, respiratory efforts, spontaneous movements, reactive pupils)
Loss of pulse <5 min prior to ED arrival or in ED
ED thoracotomy performed without immediate return of a palpable pulse in the carotid arteries after clamping the descending thoracic aorta
Exclusion Criteria:

No signs of life for >5 min prior to the decision to initiate EPR
Obvious non-survivable injury
Suggestion of traumatic brain injury, such as significant facial or cranial distortion
Electrical asystole
Rapid external assessment of the injuries suggests massive tissue trauma or blunt trauma involving multiple body regions
Pregnancy
Prisoners
Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01042015

Contacts
Contact: Samuel A Tisherman, MD 412-647-8410 tishermansa@upmc.edu

Locations
United States, Arizona
University of Arizona
Tucson, Arizona, United States, 85724
United States, Maryland
University of Maryland
Baltimore, Maryland, United States, 21201
United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
United States, Oregon
Oregon Health and Science University
Portland, Oregon, United States, 97239
United States, Pennsylvania
University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104
University of Pittsburgh
Pittsburgh, Pennsylvania, United States, 15261
Sponsors and Collaborators
University of Pittsburgh
University of Maryland
University of Pennsylvania
Massachusetts General Hospital
University of Arizona
Oregon Health and Science University
Investigators
Principal Investigator: Samuel A Tisherman, MD University of Pittsburgh
More Information

No publications provided

Responsible Party: University of Pittsburgh ( Samuel A. Tisherman, MD )
Study ID Numbers: W81XWH-07-1-0682
Study First Received: January 4, 2010
Last Updated: January 4, 2010
ClinicalTrials.gov Identifier: NCT01042015 History of Changes
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Pittsburgh:
trauma
cardiac arrest
hemorrhagic shock

Additional relevant MeSH terms:
Disease Attributes
Heart Diseases
Pathologic Processes
Wounds and Injuries
Disorders of Environmental Origin
Emergencies
Cardiovascular Diseases
Heart Arrest

ClinicalTrials.gov processed this record on March 22, 2010