ACCESS to the Cardiac Cath Lab in Patients Without STEMI Resuscitated From Out-of-hospital VT/VF Cardiac Arrest
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| ClinicalTrials.gov Identifier: NCT03119571 |
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Recruitment Status :
Terminated
(Low enrollment, funding withdrawn)
First Posted : April 18, 2017
Last Update Posted : October 19, 2020
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| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Cardiac Arrest Due to Underlying Cardiac Condition Ventricular Fibrillation Cardiopulmonary Arrest With Successful Resuscitation | Procedure: Initial CCL admission Diagnostic Test: Initial ICU admission | Not Applicable |
Primary Aim
Determine survival to hospital discharge with Modified Rankin Scale Score (mRS) ≤ 3 in adult (18-75 years old) patients resuscitated from out-of-hospital VT/VF cardiac arrest who do not have ST-segment elevation on emergency department 12-lead ECG (no-STEMI) randomized to receive either: 1) initial CCL admission, or 2) initial ICU admission.
Hypothesis: The corresponding hypothesis is that a large proportion of all resuscitated patients presenting with VT/VF have ischemic heart disease as the underlying cause for the participants cardiac arrest and that a strategy to facilitate prompt revascularization in all patients presenting with VT/VF who do not have ST-segment elevation on emergency department 12-lead ECG will improve survival with good neurological outcome.
Primary Endpoint
Survival to hospital discharge with mRS ≤ 3
Secondary Aims
Determine secondary assessments of survival, left ventricular function, hospital duration, and rehabilitation in-hospital and assessment of survival and functional status at 3 months in both groups.
Hypothesis: The corresponding hypothesis is that initial CCL admission will result in improved secondary assessment values at 3 months.
Secondary Endpoints
In-hospital secondary endpoints: Survival to hospital discharge, CPC score, mean peak troponin level, mean ejection fraction, mean length of ICU stay, mean hospitalization duration, the incidence of and mean length of rehabilitation.
3-month post-hospital discharge secondary endpoint: Survival to 3 months, survival to 3 months with mRS ≤ 3, functional status at 3 months (CPC score), incidence and length of rehabilitation, incidence of congestive heart failure, incidence of re-hospitalization over 3 months, and incidence and time to return to work.
Pragmatic Clinical Trial
The ACCESS Trial will randomize patients to receive one of two standard treatments currently practiced in the United States: either, 1) initial CCL admission, or 2) initial ICU admission. Other than randomizing to one of these two standard treatments, care is not otherwise specified and is completely at the discretion of the treating clinician, including coronary interventions, if any, hemodynamic support, medications, therapeutic hypothermia, and all other interventions and clinical care.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 65 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | ACCESS to the Cardiac Catheterization Laboratory in Patients Without ST-segment Elevation Myocardial Infarction Resuscitated From Out-of-hospital Ventricular Fibrillation Cardiac Arrest |
| Actual Study Start Date : | December 12, 2017 |
| Actual Primary Completion Date : | November 26, 2019 |
| Actual Study Completion Date : | November 26, 2019 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: Initial CCL admission
Admission to the CCL to evaluate the coronary artery disease
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Procedure: Initial CCL admission
Admission to the cardiac catheterization lab to evaluated coronary artery disease and if present fix the culprit lesion/lesions |
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Active Comparator: Initial ICU admission
Admission to the ICU to be evaluated by clinical team and the clinical treatment will be decided by the admitting/attending team.
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Diagnostic Test: Initial ICU admission
Evaluate for additional testing and/or procedures |
- Survival to hospital discharge with mRS ≤ 3 [ Time Frame: Up to 3 weeks ]mRS score
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| Ages Eligible for Study: | 18 Years to 75 Years (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Adult presumed or known to be 18-75 years old
- Resuscitated from OOHCA
- Initial cardiac arrest rhythm of pulseless VT/VF (including patients treated with an AED)
- No ST-segment elevation MI (No STEMI) (or STEMI-equivalent syndrome) on ED 12-lead ECG (as interpreted by a physician)
Exclusion Criteria:
- Initial non-shockable out-of-hospital cardiac arrest rhythm (pulseless electrical activity or asystole)
- Valid do not resuscitate orders (DNR),
- Blunt, penetrating, or burn-related injury, drowning, electrocution or known overdose,
- Known prisoners
- Known pregnancy,
- ST-segment elevation on ED 12-lead ECG (as interpreted by a physician)
- Absolute contraindications to emergent coronary angiography including,
- known anaphylactic reaction to angiographic contrast media,
- active gastrointestinal or internal bleeding, or
- severe concomitant illness that drastically shortens life expectancy or increases risk of the procedure.
- Suspected or confirmed intracranial bleeding
- Refractory cardiac arrest (prior to randomization)
- Patients meeting ACCESS Trial eligibility criteria initially seen in an outside hospital and then transferred to an ACCESS Trial participating hospital
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03119571
Show 23 study locations
| Principal Investigator: | Demetris Yannopoulos, MD | University of Minnesota | |
| Principal Investigator: | Tom Aufderheide, MD | MCW |
| Responsible Party: | University of Minnesota |
| ClinicalTrials.gov Identifier: | NCT03119571 |
| Other Study ID Numbers: |
CV-2017-25768 |
| First Posted: | April 18, 2017 Key Record Dates |
| Last Update Posted: | October 19, 2020 |
| Last Verified: | October 2020 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | Undecided |
| Studies a U.S. FDA-regulated Drug Product: | No |
| Studies a U.S. FDA-regulated Device Product: | Yes |
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Cardiac arrest Ventricular fibrillation coronary artery disease |
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Heart Arrest Ventricular Fibrillation Heart Diseases |
Cardiovascular Diseases Arrhythmias, Cardiac Pathologic Processes |