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NIH launches trials to evaluate CPR, drugs after sudden cardiac arrest
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The NIH has launched two multicenter clinical trials that will evaluate treatments for sudden cardiac arrest that occurs out of the hospital.
The CCC trial will compare survival with hospital discharge rates for two CPR approaches — continuous chest compressions combined with pause-free rescue breathing vs. standard CPR — delivered by paramedics and firefighters to those experiencing cardiac arrest. Trained emergency personnel will give all participants in the CCC trial three cycles of CPR followed by heart rhythm analysis and, if needed, defibrillation.
Standard CPR is the approach recommended by the American Heart Association for use by emergency responders; however, this approach has been called into question by emerging data that suggest stopping chest compressions to provide assisted breathing interrupts overall blood flow, thereby lowering survival, according to an NIH press release. Previous studies have shown that those who experience out-of-hospital cardiac arrest that is treated by bystanders are more likely to survive when given compressions alone, according to Graham Nichol, MD, MPH, principal investigator of the CCC trial. In 2010, the AHA adopted new guidelines that recommend continuous chest compressions only for bystanders.
“The CCC trial will help to determine if continuous compressions are equal to or better than standard professional CPR when paramedics, who are better able to provide assisted breathing than bystanders, intervene,” Nichol said in the release.
The CCC trial will enroll up to 23,600 participants at eight centers across the United States and Canada.
The ALPS trial will determine whether amiodarone or lidocaine improves survival-to-hospital discharge rates for participants with shock-resistant ventricular fibrillation. Patients will be randomly assigned to one of the drugs or placebo.
“Answering these questions is crucial and will determine the role of these drugs for patients who experience out-of-hospital cardiac arrest,” Peter Kudenchuk, MD, principal investigator of the ALPS trial, said in the release.
Up to 3,000 participants at nine centers across the United States and Canada will be enrolled in the ALPS trial.
Both trials are part of the NIH-supported Resuscitation Outcomes Consortium (ROC), the first large-scale clinical research network designed to study, improve and standardize how emergency medical service (EMS) teams deliver very early, prehospital interventions to improve patient survival after cardiac arrest or trauma. Approximately 60 fire/EMS organizations will participate in the ALPS trial, and approximately 125 EMS organizations will participate in the CCC trial. Combined, the two trials will serve a combined population of nearly 21 million people from urban, suburban and rural regions in the United States and Canada, according to information in the release.
“Increasing survival rates for people who experience out-of-hospital cardiac arrest is a major public health goal. These new trials could provide critical insight about which resuscitation efforts are more effective for cardiac arrest,” Susan B. Shurin, MD, acting director of the NHLBI, the lead federal sponsor of the studies, said in the release.
Both trials will be coordinated by the University of Washington, Seattle.
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These trials are welcome research initiatives, especially considering the 300,000 or so sudden cardiac arrests that occur annually in the United States and the appalling survival rates to hospital discharge of 5% or less. These are difficult research studies to conduct, but this area needs increased field research. Lidocaine is inferior to amiodarone in suppressing ventricular arrhythmias in the Coronary Care Unit (CCU), and it is about time that it is tested in cardiac arrest patients. I will be very surprised if it is superior to amiodarone.
– Douglas P. Zipes, MD
Cardiology
Today Section Editor
Disclosure: Dr. Zipes reports no relevant financial disclosures.
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