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Clinical Trial Details — Status: Enrolling by invitation

Administrative data

NCT number NCT04172415
Other study ID # 7148-C
Secondary ID
Status Enrolling by invitation
Phase
First received
Last updated
Start date November 30, 2019
Est. completion date October 1, 2020

Study information

Verified date November 2019
Source Niagara Health System
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

To review current Emergency Department procedural sedation practices in the community hospital setting and the associated drugs used (class of anesthetic and mode of administration). The ultimate goal of this investigation is to determine the need for a new analgesic/anesthesia drug and to compare the outcomes of a new drug within the same community Emergency Department setting. In particular, this may present a future opportunity to evaluate Penthrox (methoxyflurane) as a viable alternative for procedural sedation and analgesia in Canadian Emergency Departments.


Description:

Procedural sedation is a common practice in the Emergency Department setting. The purpose of procedural sedation is to provide adequate pain relief to patients undergoing an emergent procedure. As a result, the time to the patient's symptom relief, the degree of side effects and the duration of action of the medication are all critical to selecting an appropriate sedative and/or analgesic.

The community hospital setting may present unique challenges to successfully administering procedural sedation techniques. Funding and resource allocation can limit patient access to timely sedation/analgesia. This can be compounded by prolonged stays in the Emergency Department for recovery and/or complications.

The current recommendations for 'Procedural Sedation and Analgesia in the Emergency Department' outlines recommended medications and policies for adults and children undergoing procedural sedation1,2. While a number of cohort and retrospective analyses have been done in a variety of research settings, the role for oral or intranasal anesthesia has not been adequately explored in ED settings. The initial phase of this research proposal will identify current local practices through chart review analysis collected over the last year. Subsequent research questions might include a comparative analysis of the current procedural sedation techniques compared to medications administered orally or by inhalation. This may have considerable future benefit to patient satisfaction and clinical outcomes, as well as resource and operational outcomes in the Emergency Department.

Hypothesis

To identify interventions requiring procedural sedation and the medication commonly used in a Canadian community emergency department (ED). Using standardized medical record review methods, primary clinical patient indicators, safety outcomes and secondary ED operational outcomes will be reviewed.3

Study Design

This retrospective chart review will be obtained from data of patients who have registered in the Welland County General Hospital (WHS) from the dates of January 2017 -December 2018. This timeframe should capture a sample size of ~300 patients.

Patients will be included in our study if they have received conscious sedation for a diagnostic or therapeutic procedure in the emergency department. They will be identified through review of billing records for anesthesia codes. Medical records, specifically physician procedural sedation records and nursing documentation, will be our main resources for data extraction. The investigators will describe and quantify the procedures requiring conscious sedation and identify the medication (and route) used, using a standardized data abstraction tool to be created from international ED PSA guidelines.1,2 Primary outcome measures will include ED PSA indications, pre-procedural assessments (medical comorbidities, difficult airway predictors, other safety factors), medications used, sedation failures/use of rescue medications, procedural successes or failures, post-PSA assessments, PSA recovery and patient disposition. Further stratification by age and other demographic features will help us better understand trends between the adult and pediatric population.

Patients requiring anaesthesia for the purpose of intubation and ventilator support will be excluded from this study.

Our secondary outcomes involve resource utilization and complications. Duration of procedure and time to discharge will be measured. Data on adverse outcomes and unplanned admission rates will also be collected. Adverse outcomes of interest will be vomiting, medication for blood pressure support, dysrhythmias, unanticipated intubation, laryngospasm, pulse oximetry less than 90%, apnea requiring bag-valve-mask ventilation and death.


Recruitment information / eligibility

Status Enrolling by invitation
Enrollment 300
Est. completion date October 1, 2020
Est. primary completion date June 1, 2020
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group N/A and older
Eligibility Inclusion Criteria:

- patients who have registered in the Welland County General Hospital Emergency Department (WHS) from the dates of January 2017-December 2018.

- Patients who require procedural sedation in the Emergency Department

Exclusion Criteria:

- N/A

Study Design


Related Conditions & MeSH terms


Intervention

Other:
Retrospective cohort
Chart Review

Locations

Country Name City State
Canada Niagara Health St Catharines Ontario

Sponsors (2)

Lead Sponsor Collaborator
Amber Graystone Purdue Pharma LP

Country where clinical trial is conducted

Canada, 

Outcome

Type Measure Description Time frame Safety issue
Primary Procedural Sedation Total number of patients requiring conscious sedation 2 years
Primary Medication Use The number and type of medications used during procedure 2 years
Primary Pre Procedural Assessment Findings ASA score, 3-3-2 Abnormality, Pre-procedure Fast, Mallampatie Class, Neck Obesity, Facial Hair 2 years
Primary Sedation Failures and Use of Rescue Medications Number of occurrences where sedation is inadequate for treatment and number/type of rescue medication used to achieve adequate sedation 2 years
Primary Time of Discharge Time of patient discharge or transfer from Emergency Department 2 years
Secondary Length of time spent in Emergency Department 2 years
Secondary Duration of Procedure and Time to discharge 2 years
Secondary Number of Adverse Outcomes 2 years
Secondary Rate of Hospital Admission 2 years
Secondary Time from Triage to initiation of procedural sedation 2 years
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