Induced Hypertension for Delayed Cerebral Ischaemia After Aneurysmal Subarachnoid Haemorrhage:a Feasibility Study
Information source: UMC Utrecht
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Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Cerebral Ischemia; Subarachnoid Hemorrhage
Intervention: Induced hypertension with norepinephrine (Drug)
Phase: Phase 3
Status: Terminated
Sponsored by: UMC Utrecht
Summary
The purpose of this study is to test the feasibility of a trial on induced hypertension to
improve neurological outcome in patients with subarachnoid haemorrhage that developed the
serious complication "delayed cerebral ischemia", and to assess whether induced hypertension
results in improved cerebral blood flow (CBF) as measured by means of perfusion-CT.
Clinical Details
Official title: Induced Hypertension for Delayed Cerebral Ischaemia After Aneurysmal Subarachnoid Haemorrhage:a Feasibility Study
Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
Primary outcome: The main study parameter will be the number of SAH patients with a diagnosis of DCI who were randomised to one of the intervention groups, in whom the intervention was adequately performed, during the duration of the trial.
Secondary outcome: Related to the inclusion, to the influence on cerebral haemodynamics, to the neurological condition and to adverse events
Detailed description:
Background:
Delayed cerebral ischaemia (DCI) is a major complication after aneurysmal subarachnoid
haemorrhage (SAH). The proportion of SAH patients who develop DCI is around 30%. Many
centres around the world use induced hypertension, alone or in combination with
haemodilution and hypervolaemia, so called Triple-H, as standard therapy in the treatment of
DCI, but the efficacy of induced hypertension in reducing DCI is based on case series only,
and not on a randomised clinical trial.
Objective:
To test the feasibility of a trial on induced hypertension to improve neurological outcome,
and to assess whether induced hypertension results in improved cerebral blood flow (CBF) as
measured by means of perfusion-CT.
Study design:
A randomised controlled feasibility trial.
Study population:
Patients admitted to the UMC Utrecht after recent SAH, who develop DCI. Twenty four patients
will be randomised into a standard care group or one of the intervention groups.
Interventions:
Patients in the intervention groups are treated with induced hypertension (30 mmHg increase
in mean arterial pressure) in order to improve CBF. Patients in the standard care group are
treated according to the standardised SAH treatment protocol of the UMC Utrecht by
monitoring mean arterial pressure and preventing dropping of mean arterial pressure to under
80 mmHg. 24-36 hours after instalment of the treatment, a perfusion CT scan is performed.
In patients that do not show any neurological improvement within 24 hours after starting the
hypertensive treatment, the administration of norepinephrine will be tapered. In patients
who show improvement, induced hypertension will be continued for a total period of 72 hours,
after which norepinephrine will be gradually tapered. Measurement of CBF is performed in all
participants with perfusion CT-scanning of the brain at the beginning of the study (as part
of regular patient care) and after 24-36 hours after starting .
Main outcome measurement:
The number of patients with the diagnosis of DCI after SAH, in which the intervention
(induced hypertension) was adequately performed, included within 18 months after the start
of the study.
Eligibility
Minimum age: 18 Years.
Maximum age: N/A.
Gender(s): Both.
Criteria:
Inclusion Criteria:
1. Admission to the UMC Utrecht.
2. Age 18 years or over.
3. Aneurysmal SAH, demonstrated on CT-angiography or cerebral angiography, with onset
less than 72 hours before admission.
4. A level of consciousness corresponding to a Glasgow Coma Sum Score above 8, as in
patients with lower Glasgow Coma Sum Scores, assessment of further deterioration may
be less reliable.
Exclusion Criteria:
1. Symptomatic aneurysm not yet treated by coiling or clipping. Co-existing asymptomatic
cerebral aneurysms are no reason for exclusion, since previous studies found no
increased risk of rupture of such aneurysms during hypertensive and hypervolemic
treatment.(26)
2. Co-existing severe head injury.
3. A history of a cardiac rhythm disorder, necessitating medical treatment.
4. A history of a left ventricular pump failure, necessitating medical treatment.
5. Pregnancy.
6. Known allergy for CT-contrast agents.
7. Renal failure, defined as a serum creatinine > 150 µmol/l, because of the risk of
contrast nephropathy.
Locations and Contacts
UMC Utrecht, Utrecht 3508GA, Netherlands
Additional Information
Starting date: February 2009
Last updated: October 11, 2011
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