Acute Coronary Syndrome Clinical Trial
Official title:
Analgesia of Acute Coronary Syndromes With ST-segment Elevation in a Pre-hospital Setting. Randomized Non-inferiority Trial of the Association MEOPA + Paracetamol Versus Morphine.
In the management of acute coronary syndromes with ST-segment elevation (STEMI), early analgesia reduces the effects of hyperadrenalism which increases the size of myocardial infarction. In order to reduce pain intensity, the recommendations advocate emergency use of morphine. In STEMI patients, other analgesic treatments could provide analgesia that is at least as effective as morphine. The equimolar oxygen/nitrous oxide mixture (MEOPA) is widely used in emergency medicine and has minor secondary effects that are very rapidly reversible when inhalation is discontinued. Used in association with paracetamol, it could be an at least equally effective alternative to the use of morphine.
The investigators wish to compare the use of morphine according to current recommendations
with the use of MEOPA associated with intravenous paracetamol in the management of patients
with STEMI. The investigators hypothesize that the association of MEOPA and paracetamol,
which is easy to use in a pre-hospital setting, will give patients pain relief as effectively
as morphine.
This alternative treatment would avoid the use of morphine, whose potentially damaging
consequences on myocardial function have been suggested by experimental studies and by an
observational study. The physician of the mobile emergency team (SMUR) verifies the inclusion
and non- inclusion criteria for the study. The patient must present STEMI defined in
accordance with the recommendations and chest pain of intensity ≥ 4 on the NRS. The specific
treatment for STEMI will be given before inclusion in the study, with the exception of
analgesic treatment. In particular, inclusion in the study must not delay the initiation of
strategies of recanalization and reperfusion.
The SMUR physician in charge of the patient will administer the treatment defined by
randomization.
After 30 minutes, the patient will be managed in accordance with the recommendations and will
be hospitalized, generally in a cardiology intensive care unit. At one month, the clinical
research technician will record the patient's vital status and collect the patient's hospital
records.
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