Hemorrhagic Shock Clinical Trial
— HypoResusOfficial title:
Field Trial of Hypotensive Resuscitation Versus Standard Resuscitation in Patients With Hemorrhagic Shock After Trauma: A Pilot Trial
Verified date | December 2014 |
Source | University of Washington |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Primary Aim: To determine the feasibility and safety of hypotensive resuscitation for the
early treatment of patients with traumatic shock compared to standard fluid resuscitation.
Primary Hypotheses: The null hypothesis regarding feasibility is that hypotensive
resuscitation will result in the same volume of early crystalloid (normal saline) fluid
administration compared to standard crystalloid resuscitation. The null hypothesis regarding
safety is that hypotensive resuscitation will result in the same percent of patients
surviving to 24 hours after 911 call received at dispatch compared to standard fluid
resuscitation. Early resuscitation is defined as all fluid given until 2 hours after arrival
in the Emergency Department or until hemorrhage control is achieved in the hospital,
whichever occurs earlier.
Status | Completed |
Enrollment | 192 |
Est. completion date | April 2013 |
Est. primary completion date | April 2013 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 15 Years and older |
Eligibility |
Inclusion Criteria: Included will be those with: - Blunt or penetrating injury - Age =15yrs or weight =50kg if age is unknown - Prehospital SBP = 90 mmHg Exclusion Criteria: Excluded will be those with: - Ground level falls - Evidence of severe blunt or penetrating head injury with a Glasgow Coma Scale (GCS) = 8 - Bilateral paralysis secondary to suspected spinal cord injury - Fluid greater than 250ml was given prior to randomization - Cardiopulmonary resuscitation (CPR) by Emergency Medicine Service (EMS) prior to randomization - Known prisoners - Known or suspected pregnancy - Drowning or asphyxia due to hanging - Burns over a Total Body Surface Area (TBSA) > 20% - Time of call received at dispatch to study intervention > 4 hours |
Country | Name | City | State |
---|---|---|---|
Canada | Resuscitation Outcomes Consortium Regional Coordinating Center,University of British Columbia | Vancouver | British Columbia |
United States | Alabama Resuscitation Center, University of Alabama | Birmingham | Alabama |
United States | Dallas Center for Resuscitation Research, University of Texas Southwestern Medical Center | Dallas | Texas |
United States | Milwaukee Resuscitation Network, Medical College of Wisconsin | Milwaukee | Wisconsin |
United States | The Pittsburgh Resuscitation Network, University of Pittsburgh | Pittsburgh | Pennsylvania |
United States | Portland Resuscitation Outcomes Consortium, Oregon Health & Sciences University | Portland | Oregon |
Lead Sponsor | Collaborator |
---|---|
University of Washington | Canadian Institutes of Health Research (CIHR), National Heart, Lung, and Blood Institute (NHLBI) |
United States, Canada,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Total Volume of All Crystalloid Given for Early Resuscitation (Feasibility) | The primary feasibility endpoint was early crystalloid volume (ECV) defined as crystalloid infused from Emergency Medical Services (EMS) arrival at the scene until the end of the study period | From time of first intravenous or intraosseous insertion through the first 2 hours after hospital arrival or hemorrhage control, which ever occurs first | |
Primary | 24 Hour Mortality | The 24 hour mortality endpoint for the total number of patients each arm | From time of hospital arrival through the first 24 hours | |
Secondary | Number of Ineligible Patients Enrolled at the Time of Randomization | Eligibility criteria: Inclusion Criteria Included will be those with: Blunt or penetrating injury Age =15yrs or weight =50kg if age is unknown Prehospital SBP = 90 mmHg 5.3 Exclusion Criteria Excluded will be those with: Ground level falls Evidence of severe blunt or penetrating head injury with a Glasgow Coma Score (GCS) = 8 Bilateral paralysis secondary to suspected spinal cord injury Fluid greater than 250 ml was given prior to randomization Cardiopulmonary resuscitation (CPR) by Emergency Medical Services (EMS) prior to randomization Known prisoners Known or suspected pregnancy Drowning or asphyxia due to hanging Burns Total Body Surface Area (TBSA) > 20% Time of call received at dispatch to study intervention > 4 hours |
From the time the paramedic with study drug kit arrived at patient's side to the time kit was opened prior to ED arrival | |
Secondary | Total Fluid Requirement During First 24 Hours | Total volume of fluid administered during the first 24 hours inclusive of crystalloids, blood products, 3% saline, mannitol, and other colloids | From ED arrival through the first 24 hours | |
Secondary | Total Blood Product Requirements in First 24 Hours | Total amount of blood products required: packed red blood cells (PRBC), fresh frozen plasma (FFP), platelets (plts), cryoprecipitate (cryo) | From ED arrival through the first 24 hours | |
Secondary | Base Deficit on Admission to the Emergency Department (ED) | The first base deficit value reported from arterial blood lab work drawn after arrival in the final Emergency Department. This measure reflects the acid-base balance in the arterial blood. A negative number indicates that the blood is more acid that normal. | From final Emergency Department arrival time through first 24 hours | |
Secondary | Hemoglobin on Admission to the Emergency Department | The first hemoglobin value reported from blood drawn in the final Emergency Department | From final Emergency Department arrival time through first 24 hours | |
Secondary | Platelet Value on Admission | First platelet value from blood drawn in the the first 24 hours after arrival | From final Emergency Department arrival time through first 24 hours | |
Secondary | International Normalized Ratio (INR) on Admission to the Emergency Department | The first International normalized ratio (INR) value reported from blood drawn within the first 24 hours from arrival | From final Emergency Department arrival time through first 24 hours | |
Secondary | Hemorrhage Control Procedure Within 2 Hours of ED Arrival | Hemorrhage control procedures include blood vessel ligated or embolized, organ packed or removed, laparotomy or thoracotomy | From ED arrival through the first 2 hours | |
Secondary | Acute Renal Failure Classification Score of "Risk" Without Glomerular Filtration Rate (GFR) | Increased plasma creatinine > 1.5 x reference measure (ED admission). Urine criteria is based on 6-hour periods for this level of the RIFLE and cannot be assessed since study data are collected for 24-hour periods. This row includes patients who met the "Injury" and "Failure" criteria as well. Only measured for patients with at least 2 days of ICU stay assessed. | From ED arrival through Day 28 | |
Secondary | Acute Renal Failure Classification Score of "Injury" Without Glomerular Filtration Rate (GFR) | Increased plasma creatinine > 2 x reference measure (ED admission) or urine output < 0.5 mL/kg/h x 24h. The RIFLE urine criterion for this level actually specifies a 12 hour period of assessment but study data are collected for 24-hr periods. This row includes patients who met the "Failure" criteria as well. Only measured for patients with at least 2 days of ICU stay assessed. | From ED arrival through Day 28 | |
Secondary | Acute Renal Failure Classification Score of "Failure" Without Glomerular Filtration Rate (GFR) | Increased plasma creatinine > 3 x reference measure (ED admission) or acute plasma creatinine = 350 umol/L or acute rise = 44 umol/L or urine output < 0.3 mL/k/h x 24h. Only measured for patients with at least 2 days of ICU stay assessed. | From ED arrival through the first 24 hours | |
Secondary | Ventilator Free Days Through Day 28 | The number of days beginning with the day of the 911 call counted as "Day 0" through Day 28 during which the patient did not require mechanical ventilation. Deaths are assigned the worst score (0). | From day of the 911 call through Day 28 | |
Secondary | Days Alive Out of the Intensive Care Unit (ICU) Through Day 28 | The number of days beginning with the day of the 911 call counted as "Day 0" through Day 28 during which the patient is alive and not being cared for in the intensive care unit | From day of the 911 call through Day 28 | |
Secondary | Days Alive Out of the Hospital Through Day 28 | The number of days beginning with the day of the 911 call counted as "Day 0" through Day 28 during which the patient is alive and not being cared for in the hospital | From day of the 911 call through Day 28 | |
Secondary | Blunt Trauma 24 Hour Mortality | The 24 hour mortality endpoint for the total number of patients injured by blunt mechanisms in each arm. | From time of hospital arrival through first 24 hours | |
Secondary | Penetrating Trauma 24 Hour Mortality | The 24 hour mortality endpoint for the total number of patients injured by penetrating mechanisms in each arm. | From time of hospital arrival through first 24 hours | |
Secondary | In-hospital Mortality | Number of patients who died prior to discharge. | From day of the 911 call through hospital discharge |
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