To compare the effects of central versus peripheral drug administration on the rate of return of organised electrical activity and/or spontaneous circulation during CPR.
ID
Source
Brief title
Condition
- Heart failures
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Combined primary endpoint: rate of appearance of organised electrical activity
or return of spontaneous circulation.
Secondary outcome
- time to primary endpoints
- Complications following external jugular cannulation: arterial puncture,
bleeding.
- Does central external jugular cannulation interfere with chest compressions?
- Time needed for obtaining jugular access.
- 1- and 7- day survival rate.
Background summary
Vascular access for drug administration during cardiopulmonary resuscitation
(CPR) is routinely obtained in the extremities. During chest compression
facilitated circulation, however, circulating blood is preferential directed to
the heart and brain at the expense of abdominal organs and peripheral
circulation. Peripheral administration could therefore limit the efficacy of
resuscitation drugs that must reach the heart, their primary site of action, as
effectively as possible.
Previous animal studies reported faster and higher central peak drug
concentrations during CPR after central versus peripheral administration. This
finding was supported in a small human study. However, this evidence in favour
of central drug administration appears to have been neglected. In addition, it
is undetermined whether pharmacokinetic differences between central and
peripheral access routes are clinically relevant.
We hypothesize that, during CPR, central administration of resuscitation drugs,
compared to standard treatment via a peripheral access, is associated with
enhancement of signs of cardiac effects of these drugs, in particular return of
organised electrical activity and/or of spontaneous circulation.
Study objective
To compare the effects of central versus peripheral drug administration on the
rate of return of organised electrical activity and/or spontaneous circulation
during CPR.
Study design
Randomized clinical trial
Intervention
Central venous access
Study burden and risks
All patients are treated according to the guidelines of the European
Resuscitation Council, which are endorsed by the local VUMC CPR-committee.
Central access will be obtained by cannulation of the external or internal
jugular vein by an experienced physician. To avoid interference with initial
management, central venous access will be obtained after initiation of chest
compressions, first attempt at defibrillation (if applicable), securing the
airway and obtaining a peripheral access.
All resuscitated patients require vascular access and almost all successfully
resuscitated patients require central venous access. Obtaining central access
during CPR may be associated with a slightly higher complication rate, such as
arterial puncture and pneumothorax. Possible benefits for study subjects are a
higher success rate of CPR.
De Boelelaan 1117
Amsterdam 1081 HV
NL
De Boelelaan 1117
Amsterdam 1081 HV
NL
Listed location countries
Age
Inclusion criteria
Hospitalized patients and patients presenting at the emergency department, older than 18 years, requiring cardiopulmonary resuscitation
Exclusion criteria
- age <18 years
- circulatory arrest following major bleeding or trauma
- central venous access in-situ at time of commencement of CPR
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL40187.029.12 |