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AzTrials

Cardiac ArrestNCT01325870

Hemodynamic Effects of Standard Cardiopulmonary Resuscitation (CPR), Active Compression Decompression CPR With an Inspiratory Impedance Device, and Standard CPR With an Intrathoracic Pressure Regulator During Out-of-hospital Cardiac Arrest

A study testing ACD-CPR, ITPR and S-CPR in people with Cardiac Arrest and Sudden Cardiac Death, run by Advanced Circulatory Systems at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

More than 300,000 Americans experience out-of-hospital cardiac arrest annually, with overall survival rates averaging less than 5%. Low survival rates persist, in part, because manual chest compressions and ventilation, termed standard cardiopulmonary resuscitation (S-CPR), is an inherently inefficient process… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Cardiac Arrest, Sudden Cardiac Death
What is being tested?
ACD-CPR, ITPR and S-CPR
Could I receive a placebo?
No, everyone receives an active treatment
How many people
48 participants
Where
1 siteUnited States
Study dates
Mar 2011to Dec 2012
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Initial Inclusion Criteria:

  • Subject is initially presumed or known to be 18 years of age or older;
  • Subject presents with presumed non-traumatic, out-of-hospital cardiac arrest AND is a candidate for resuscitation attempt. [NOTE: the cardiac arrest may be witnessed OR unwitnessed];
  • Subject has a secured cuffed advanced airway [e.g., endotracheal tube, Combitube, King airway].

Final Inclusion Criteria:

  • Subject in whom femoral arterial access was successfully established;
  • Subject remained in cardiac arrest (undergoing CPR) at the time of hemodynamic data acquisition;
  • Subject in whom at least 5 minutes of continuous hemodynamic data were able to be collected, OR if ROSC occurs before 5 minutes, at least 2 minutes of hemodynamic data were able to be collected.

Initial Exclusion Criteria:

  • Subject has known pre-existing DNR orders in place prior to this cardiac arrest;
  • Subject has signs of obvious clinical death or conditions that preclude the use of CPR;
  • Subject's family or legal guardians request that the subject not be entered in the study at the time of arrest;
  • Subject has recent sternotomy, with wound not appearing completely healed (if date of sternotomy is unknown) or less than six months (if date of sternotomy is known);
  • Subject has a stoma, tracheotomy, or tracheostomy prior to arrest;
  • Subject is known or suspected to be pregnant;
  • Subject is known/suspected to be a prisoner.

Final Exclusion Criteria:

  • Subject in whom < 2 minutes of hemodynamic data were acquired while receiving CPR;
  • Subject in whom an arterial pressure catheter was not placed or arterial pressure was not able to be successfully monitored;
  • Subject is subsequently found to have had a traumatic arrest;
  • Subject was in asystole at time of initial arrest AND remained in asystole during resuscitation effort AND arrest was unwitnessed or unknown if witnessed.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Michigan State University- Kalamazoo Center for Medical Studies

    Kalamazoo, Michigan, 49008

Other trials in United States

About this study

Official title: Comparison of Standard Cardiopulmonary Resuscitation Alone Versus Active Compression Decompression Cardiopulmonary Resuscitation Plus an Impedance Threshold Device Versus Standard Cardiopulmonary Resuscitation Plus an Intrathoracic Pressure Regulator on Arterial Blood Pressures During Out-of-Hospital Cardiac Arrest

More than 300,000 Americans experience out-of-hospital cardiac arrest annually, with overall survival rates averaging less than 5%. Low survival rates persist, in part, because manual chest compressions and ventilation, termed standard cardiopulmonary resuscitation (S-CPR), is an inherently inefficient process, providing less than 25% of normal blood flow to the heart and the brain. Hemodynamics are often compromised further by poor S-CPR techniques, especially inadequate chest compression and incomplete chest recoil. Active Compression Decompression CPR (ACD-CPR) is performed with a hand-held device that is attached to the patient's chest, and also includes a handle containing a metronome and force gauge to guide proper compression rate, depth and complete chest wall recoil. The impedance threshold device (ITD) is designed for rapid connection to an airway adjunct (e.g. facemask or endotracheal tube) and allows for positive pressure ventilation, while also impeding passive inspiratory gas exchange during chest wall decompression. Prior studies have shown that the combination of ACD-CPR + ITD enhances refilling of the heart after each compression by augmenting negative intrathoracic pressure during the decompression phase of CPR, resulting in improved cardiac and cerebral perfusion. The intrathoracic pressure regulator (ITPR) is a next generation inspiratory impedance therapy. The ITPR uses a regulated external vacuum source to lower the negative intrathoracic pressure and is therefore less dependent on the quality of CPR (e.g., completeness of chest wall recoil). The ITPR generates a pre-set continuous and controlled expiratory phase negative intrathoracic pressure that is interrupted only when positive pressure ventilation is needed to maintain oxygenation and provide gas exchange.

The purpose of the study is to compare the early safety and hemodynamic effects of S-CPR, ACD- CPR + ITD, and S-CPR + ITPR in patients with out-of-hospital cardiac arrest.

Being tested
ACD-CPR, ITPR, S-CPR, Impedance Threshold Device (ITD)
Keywords
cardiopulmonary resuscitation
Medical subject headings
Heart Arrest, Death, Sudden, Cardiac

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ACD-CPRDevice

    Also called ResQPRO Active Compression Decompression CPR Device (Advanced Circulatory Systems, Inc., Roseville, MN)

  • ITPRDevice

    Also called CirQlator Intrathoracic Pressure Regulator (Advanced Circulatory Systems, Inc., Roseville, MN)

    standard CPR with use of the CirQlator intrathoracic pressure regulator (ITPR)

  • S-CPRProcedure or surgery

    standard manual CPR

  • Impedance Threshold Device (ITD)Device

    Also called ResQPOD 16 (Advanced Circulatory Systems, Inc)

Study groups in NCT01325870
Study groupRoleWhat they receive
ACD-CPR +ITDExperimentalActive Compression Decompression CPR with the ResQPRO device and ResQPOD ITD device.
Receives: Device: ACD-CPR; Device: Impedance Threshold Device (ITD)
S-CPR + ITPRExperimentalNot described
Receives: Device: ITPR
S-CPRActive comparatorNot described
Receives: Procedure: S-CPR

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Mean Systolic and Diastolic Blood Pressures

    Measured: during CPR (day 1)

  2. Serious Adverse Events

    Serious adverse events include: death, internal thoracic and abdominal injuries, device malfunction preventing use during CPR

    Measured: during the index CPR procedure (day 1), at hospital discharge, at 30 days, at three months, and at six months of follow-up

Secondary outcomes (1)
  1. Mean Intrathoracic Pressure (Airway Pressure)

    Intrathoracic pressures are reported relative to atmospheric pressure

    Measured: during CPR (day 1)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted30 Mar 2011 (estimated)
  2. Study startMar 2011
  3. Primary completionDec 2012
  4. Study completionDec 2012

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
48 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01325870
Sponsor's protocol ID
43-0566-000
Other IDs
2R44HL082088
Status last verified
Jul 2016
First submitted
28 Mar 2011
Last updated
12 Aug 2016
Data monitoring committee
Yes

Publications

  • Niemann JT. Cardiopulmonary resuscitation. N Engl J Med. 1992 Oct 8;327(15):1075-80. doi: 10.1056/NEJM199210083271507. No abstract available.

    PubMed 1522844
  • Duggal C, Weil MH, Gazmuri RJ, Tang W, Sun S, O'Connell F, Ali M. Regional blood flow during closed-chest cardiac resuscitation in rats. J Appl Physiol (1985). 1993 Jan;74(1):147-52. doi: 10.1152/jappl.1993.74.1.147.

    PubMed 8444685
  • Lurie KG, Voelckel WG, Zielinski T, McKnite S, Lindstrom P, Peterson C, Wenzel V, Lindner KH, Samniah N, Benditt D. Improving standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve in a porcine model of cardiac arrest. Anesth Analg. 2001 Sep;93(3):649-55. doi: 10.1097/00000539-200109000-00024.

    PubMed 11524335
  • Langhelle A, Stromme T, Sunde K, Wik L, Nicolaysen G, Steen PA. Inspiratory impedance threshold valve during CPR. Resuscitation. 2002 Jan;52(1):39-48. doi: 10.1016/s0300-9572(01)00442-7.

    PubMed 11801347
  • Lurie KG, Coffeen P, Shultz J, McKnite S, Detloff B, Mulligan K. Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve. Circulation. 1995 Mar 15;91(6):1629-32. doi: 10.1161/01.cir.91.6.1629.

    PubMed 7882467
  • Plaisance P, Lurie KG, Payen D. Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation: a randomized evaluation in patients in cardiac arrest. Circulation. 2000 Mar 7;101(9):989-94. doi: 10.1161/01.cir.101.9.989.

    PubMed 10704165
  • Plaisance P, Lurie KG, Vicaut E, Adnet F, Petit JL, Epain D, Ecollan P, Gruat R, Cavagna P, Biens J, Payen D. A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. French Active Compression-Decompression Cardiopulmonary Resuscitation Study Group. N Engl J Med. 1999 Aug 19;341(8):569-75. doi: 10.1056/NEJM199908193410804.

    PubMed 10451462
  • Voelckel WG, Lurie KG, Sweeney M, McKnite S, Zielinski T, Lindstrom P, Peterson C, Wenzel V, Lindner KH. Effects of active compression-decompression cardiopulmonary resuscitation with the inspiratory threshold valve in a young porcine model of cardiac arrest. Pediatr Res. 2002 Apr;51(4):523-7. doi: 10.1203/00006450-200204000-00020.

    PubMed 11919340
  • Wolcke BB, Mauer DK, Schoefmann MF, Teichmann H, Provo TA, Lindner KH, Dick WF, Aeppli D, Lurie KG. Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest. Circulation. 2003 Nov 4;108(18):2201-5. doi: 10.1161/01.CIR.0000095787.99180.B5. Epub 2003 Oct 20.

    PubMed 14568898
  • Shultz JJ, Coffeen P, Sweeney M, Detloff B, Kehler C, Pineda E, Yakshe P, Adler SW, Chang M, Lurie KG. Evaluation of standard and active compression-decompression CPR in an acute human model of ventricular fibrillation. Circulation. 1994 Feb;89(2):684-93. doi: 10.1161/01.cir.89.2.684.

    PubMed 8313556
  • Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 2: ethical aspects of CPR and ECC. Circulation. 2000 Aug 22;102(8 Suppl):I12-21. No abstract available.

    PubMed 10966661
  • Aufderheide TP, Pirrallo RG, Yannopoulos D, Klein JP, von Briesen C, Sparks CW, Deja KA, Conrad CJ, Kitscha DJ, Provo TA, Lurie KG. Incomplete chest wall decompression: a clinical evaluation of CPR performance by EMS personnel and assessment of alternative manual chest compression-decompression techniques. Resuscitation. 2005 Mar;64(3):353-62. doi: 10.1016/j.resuscitation.2004.10.007.

    PubMed 15733766
  • Yannopoulos D, Aufderheide TP, Gabrielli A, Beiser DG, McKnite SH, Pirrallo RG, Wigginton J, Becker L, Vanden Hoek T, Tang W, Nadkarni VM, Klein JP, Idris AH, Lurie KG. Clinical and hemodynamic comparison of 15:2 and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation. Crit Care Med. 2006 May;34(5):1444-9. doi: 10.1097/01.CCM.0000216705.83305.99.

    PubMed 16557155
  • Aufderheide TP, Pirrallo RG, Provo TA, Lurie KG. Clinical evaluation of an inspiratory impedance threshold device during standard cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest. Crit Care Med. 2005 Apr;33(4):734-40. doi: 10.1097/01.ccm.0000155909.09061.12.

    PubMed 15818098
  • Lurie K, Voelckel W, Plaisance P, Zielinski T, McKnite S, Kor D, Sugiyama A, Sukhum P. Use of an inspiratory impedance threshold valve during cardiopulmonary resuscitation: a progress report. Resuscitation. 2000 May;44(3):219-30. doi: 10.1016/s0300-9572(00)00160-x.

    PubMed 10825624

Questions about this trial

What is this clinical trial studying?

A study testing ACD-CPR, ITPR and S-CPR in people with Cardiac Arrest and Sudden Cardiac Death, run by Advanced Circulatory Systems at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Aug 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 17 Jul 2014). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Mean Systolic and Diastolic Blood Pressures (time frame: during CPR (day 1)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01325870, which also lists 30 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Aug 2016.

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