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Cardiac ArrestINCEPTIONNCT03101787

Early Initiation of Extracorporeal Life Support in Refractory OHCA

A study testing Extracorporeal cardiopulmonary resuscitation (ECPR) in people with Cardiac Arrest and Out-Of-Hospital Cardiac Arrest, run by Maastricht University Medical Center at 10 sites in Netherlands.

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

Despite adequate conventional cardiopulmonary resuscitation (CCPR) and attempted defibrillation, a considerable number of patients in cardiac arrest fail to achieve sustained return of spontaneous circulation. Read more about this study

Who is it for?
Ages 18 to 70 years
What is being tested?
Extracorporeal cardiopulmonary resuscitation (ECPR)
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
134 participants
Where
10 sitesNetherlands
Study dates
1 May 2017to 10 Feb 2022
Phase
Interventional
Are there results?
None posted in the registry

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 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • ≥18 - ≤70 years
  • Witnessed OHCA (by bystanders)
  • Initial rhythm of VF/VT or AED administered
  • Bystander BLS

Who cannot join

  • ROSC within 15 minutes of conventional CPR with sustained hemodynamic recovery
  • Terminal heart failure (NYHA III or IV)
  • Severe pulmonary disease (COPD GIII of GIV)
  • Disseminated oncological disease
  • Obvious or suspected pregnancy
  • Bilateral femoral bypass surgery
Show all 11Show fewer
  • Known contraindications for ECPR
  • Known pre-arrest CPC-score of 3 or 4
  • Known limitations in therapy or a Do Not Resuscitate-order
  • Multitrauma (Injury Severity Score >15)
  • Expected time-to-start cannulation > 60 minutes

Trial locations and contacts

10 sites in 1 country.

10 sites in 1 country

Netherlands10 sites
  • Academisch Medisch Centrum

    Amsterdam, North Holland

  • Onze Lieve Vrouwen Gasthuis

    Amsterdam

  • Catharina Ziekenhuis

    Eindhoven, North Brabant

  • Leids Universitair Medisch Centrum

    Leiden, South Holland

  • Maastricht UMC

    Maastricht, Limburg

  • St. Antonius Hospital

    Nieuwegein, Utrecht, 3435 CM

  • Erasmus MC

    Rotterdam

  • HagaZiekenhuis

    The Hague

  • Universitair Medisch Centrum Utrecht

    Utrecht

  • Isala Klinieken

    Zwolle, Overijssel

Other trials in Netherlands

About this study

Official title: Early Initiation of Extracorporeal Life Support in Refractory OHCA (INCEPTION)

Despite adequate conventional cardiopulmonary resuscitation (CCPR) and attempted defibrillation, a considerable number of patients in cardiac arrest fail to achieve sustained return of spontaneous circulation. The INCEPTION trial is a multicenter, randomized controlled trial that will explore extracorporeal cardiopulmonary resuscitation (ECPR) in patients in refractory out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation or tachycardia. It aims to determine the effect on survival and neurological outcome. Additionally, it will evaluate the feasibility and cost-effectiveness of ECPR.

Read the detailed description

There are approximately 275,000 cases of out-of-hospital cardiac arrest (OHCA) per year in Europe, of which two-thirds have a primary cardiac origin. However, despite adequate conventional cardiopulmonary resuscitation (CCPR) and attempted defibrillation, a considerable number of these patients fail to achieve sustained return of spontaneous circulation (ROSC).

Treatment of the underlying cause of the arrest, in most cases coronary artery occlusion, is paramount. But in the absence of ROSC, the possibilities to perform these life-saving interventions are limited. Continued CCPR is currently the standard of care for these patients. Initiation of extracorporeal cardiopulmonary resuscitation (ECPR) restores circulation, with the potential to minimize (or even reversing) organ damage, prevent re-arrest due to ischemia-triggered myocardial dysfunction and providing a bridge to possible diagnosis and treatment. Several studies have demonstrated that ECPR is feasible and may be advantageous with respect to survival and neurological outcome.

The INCEPTION trial aims to compare ECPR to CCPR in the population that is expected to benefit the most from this intervention: young patients presenting with ventricular fibrillation or tachycardia (VF/VT) and a refractory cardiac arrest. Furthermore, it will provide data on the cost-effectiveness of this intervention, which to date has been unavailable. Although the costs may prove to be high, the gain in quality-adjusted life years (QALY's) may be substantial given the fact that most patients are relatively young and the current alternative carries a poor prognosis. This can determine whether ECPR should be pursued as a standard of care in patients with refractory arrest.

Being tested
Extracorporeal cardiopulmonary resuscitation (ECPR)
Keywords
ECPR, Extracorporeal CardioPulmonary Resuscitation, OHCA, Out-of-Hospital Cardiac Arrest, CPR, CardioPulmonary Resuscitation, ECMO, ExtraCorporeal Membrane Oxygenation, Refractory Cardiac Arrest
Medical subject headings
Heart Arrest, Out-of-Hospital Cardiac Arrest, Death, Sudden, Cardiac

What participants receive

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

  • Extracorporeal cardiopulmonary resuscitation (ECPR)Procedure or surgery

    In addition to the routine response team, the ECLS team are called to the ED while the patient is transported to the hospital.

    The team consists of a physician skilled and qualified in femoral cannulation, a perfusionist and a scrub nurse.

    Upon the patient's arrival at the emergency department, CPR will be continued, with continuation of mechanical chest compressions with minimization of interruptions.

    Time from arrest to start of cannulation is < 60 minutes.

Study groups in NCT03101787
Study groupRoleWhat they receive
CCPR protocolNo interventionPreclinical Cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) and rapid transport to the emergency department with ongoing mechanical CPR and advanced cardiac life support (ACLS). Clinical Upon the patient's arrival, the standard of care (CCPR) will be continued according to ERC guidelines. No special preparations for the trial are needed before the patient's arrival.
ECPR protocolExperimentalPreclinical Cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) and transport to the emergency department with ongoing mechanical CPR and advanced cardiac life support (ACLS). Clinical The ECPR team is mobilized while the patient is transported to the hospital. Initiation of extracorporeal cardiopulmonary resuscitation (ECPR). Time from arrest to start of cannulation is < 60 minutes.
Receives: Procedure: Extracorporeal cardiopulmonary resuscitation (ECPR)

What is being measured

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

  1. 30-day survival rate with favorable neurological status

    Favorable neurological status is defined as 1 or 2 on the using Cerebral Performance Category scale

    Measured: 30 days

Secondary outcomes (15)
  1. Neurological outcome on the CPC scale

    Does ECPR improve the neurological outcome at 30 days, 3 months, 6 months and 12 months on the CPC scale

    Measured: 30 days, 3 months, 6 months and 12 months

  2. Quality Adjusted Life Years (QALY's)

    Does ECPR improve the amount of Quality Adjusted Life Years (QALY's) at 30 days, 3 months, 6 months and 12 months

    Measured: 30 days, 3 months, 6 months and 12 months

  3. Reason for discontinuation of treatment between the treatment groups

    Is there a difference in reason for discontinuation of treatment between the treatment groups

    Measured: Within 1 year

  4. Time to return of circulation

    What is the time to return of circulation

    Measured: Within 1 year

  5. Additional costs of ECPR with respect to CCPR

    What are the additional costs of ECPR with respect to CCPR

    Measured: 1 year

  6. Costs per gained QALY for ECPR vs. CCPR

    What are the costs per gained QALY for ECPR vs. CCPR

    Measured: 1 year

  7. Length of stay at the ICU

    Is there a difference in length of stay at the ICU between the treatment groups

    Measured: 1 year

  8. Length of stay at the hospital

    Is there a difference in length of stay at the hospital between the treatment groups

    Measured: 1 year

  9. Duration of clinical rehabilitation time

    Is there a difference in the duration of clinical rehabilitation time

    Measured: 1 year

  10. Duration of mechanical ventilation

    Is there a difference in the duration of mechanical ventilation between treatment groups

    Measured: 1 year

  11. Need for renal replacement therapy

    Is there a difference in need for renal replacement therapy between the treatment groups

    Measured: 1 year

  12. Acute kidney injury according to the RIFLE criteria

    Is there a difference in acute kidney injury according to the RIFLE criteria

    Measured: 1 year

  13. Time to target hypothermia

    Is there a difference in time to target hypothermia between the treatment groups

    Measured: 1 year

  14. Difference in metabolic markers between treatment groups

    Is there a difference in metabolic markers such as (1) pH, (2) etCO2, (3) ScVO2 and (4) lactate at arrival at the ED, right after initialization of circulation (either by ROSC or ECPR), 1, 2, 3, 4, 5 and 6 hours after return of circulation and at 1, 2, 3, 4, 5 and 6 days after the OHCA between the treatment groups

    Measured: 6 days

  15. Difference in metabolic markers between between the survivors and non-survivors

    Is there a difference in metabolic markers such as (1) pH, (2) etCO2, (3) ScVO2 and (4) lactate at arrival at the ED, right after initialization of circulation (either by ROSC or ECPR), 1, 2, 3, 4, 5 and 6 hours after return of circulation and at 1, 2, 3, 4, 5 and 6 days after the OHCA between the survivors and non-survivors

    Measured: 6 days

Timeline

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

  1. First posted5 Apr 2017
  2. Study start1 May 2017
  3. Primary completion10 Feb 2021
  4. Study completion10 Feb 2022

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
134 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03101787
Sponsor's protocol ID
NL58067.068.16
Acronym
INCEPTION
Status last verified
Aug 2022
First submitted
30 Mar 2017
Last updated
18 Oct 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Verberght HCR, Delnoij TSR, Suverein MM, Lunsing J, Hermanides RC, Otterspoor L, Elzo Kraemer CV, Vlaar APJ, van der Heijden JJ, Scholten E, Uil CAD, Miranda DDR, Akin S, Metz J, van der Horst ICC, Mathot BJ, de Jonge J, Nijboer MWN, de Meijer VE, Sanders JSF, Christiaans MHL, van Zuilen AD, Hagenaars H, Wind J, Danhof M, Olde Damink SWM, Winkens B, Maessen JG, Lorusso R, van de Poll MCG; INCEPTION-investigators. Organ Donor Potential After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A Post-Hoc Analysis of a Randomized Controlled Trial. Clin Transplant. 2025 Nov;39(11):e70382. doi: 10.1111/ctr.70382.

    PubMed 41243868
  • Ubben JFH, Heuts S, Delnoij TSR, Suverein MM, Hermanides RC, Otterspoor LC, Kraemer CVE, Vlaar APJ, van der Heijden JJ, Scholten E, den Uil C, Dos Reis Miranda D, Akin S, de Metz J, van der Horst ICC, Winkens B, Maessen JG, Lorusso R, van de Poll MCG. Favorable resuscitation characteristics in patients undergoing extracorporeal cardiopulmonary resuscitation: A secondary analysis of the INCEPTION-trial. Resusc Plus. 2024 May 13;18:100657. doi: 10.1016/j.resplu.2024.100657. eCollection 2024 Jun.

    PubMed 38778803
  • Heuts S, van de Koolwijk AF, Gabrio A, Ubben JFH, van der Horst ICC, Delnoij TSR, Suverein MM, Maessen JG, Lorusso R, van de Poll MCG. Extracorporeal life support in cardiac arrest: a post hoc Bayesian re-analysis of the INCEPTION trial. Eur Heart J Acute Cardiovasc Care. 2024 Feb 16;13(2):191-200. doi: 10.1093/ehjacc/zuad130.

    PubMed 37872725
  • Suverein MM, Delnoij TSR, Lorusso R, Brandon Bravo Bruinsma GJ, Otterspoor L, Elzo Kraemer CV, Vlaar APJ, van der Heijden JJ, Scholten E, den Uil C, Jansen T, van den Bogaard B, Kuijpers M, Lam KY, Montero Cabezas JM, Driessen AHG, Rittersma SZH, Heijnen BG, Dos Reis Miranda D, Bleeker G, de Metz J, Hermanides RS, Lopez Matta J, Eberl S, Donker DW, van Thiel RJ, Akin S, van Meer O, Henriques J, Bokhoven KC, Mandigers L, Bunge JJH, Bol ME, Winkens B, Essers B, Weerwind PW, Maessen JG, van de Poll MCG. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. N Engl J Med. 2023 Jan 26;388(4):299-309. doi: 10.1056/NEJMoa2204511.

    PubMed 36720132
  • Bol ME, Suverein MM, Lorusso R, Delnoij TSR, Brandon Bravo Bruinsma GJ, Otterspoor L, Kuijpers M, Lam KY, Vlaar APJ, Elzo Kraemer CV, van der Heijden JJ, Scholten E, Driessen AHG, Montero Cabezas JM, Rittersma SZH, Heijnen BG, Taccone FS, Essers B, Delhaas T, Weerwind PW, Roekaerts PMHJ, Maessen JG, van de Poll MCG. Early initiation of extracorporeal life support in refractory out-of-hospital cardiac arrest: Design and rationale of the INCEPTION trial. Am Heart J. 2019 Apr;210:58-68. doi: 10.1016/j.ahj.2018.12.008. Epub 2018 Dec 14.

    PubMed 30738245

Questions about this trial

What is this clinical trial studying?

A study testing Extracorporeal cardiopulmonary resuscitation (ECPR) in people with Cardiac Arrest and Out-Of-Hospital Cardiac Arrest, run by Maastricht University Medical Center at 10 sites in Netherlands.

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

Who may be eligible to take part?

The sponsor lists 4 inclusion and 11 exclusion criteria. 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 18 Oct 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in Netherlands. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

30-day survival rate with favorable neurological status (time frame: 30 days). 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 NCT03101787, which also lists 5 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 18 Oct 2022.

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