Efficacy of Early Intravenous High-dose Vitamin C in Post-cardiac Arrest Shock.

Official title

Efficacy of Early Intravenous High-dose Vitamin C in Post-cardiac Arrest Shock: a Multicenter, Randomized Controled Trial.

Overview

Among patients admitted after an out-of-hospital cardiac arrest (OHCA) in intensive care unit (ICU), almost two thirds of patients will develop in the first hours a post-cardiac arrest (CA) shock. This post-CA shock, combines cardiac and hemodynamic failure, generally resulting in multi-organ failure and early death in up to 35% of patients. Experimental data suggest that intravenous ascorbic acid (vitamin C) may attenuate inflammation and vascular injury related to sepsis or surgery. Preclinical and clinical studies also provide safety data of high dose intravenous vitamin C (\> 200mg/kg/day) with no significant adverse event reported and favorable impact on outcome. Experimental data also suggest beneficial effect of vitamin C in post-CA management with improvement of shock and multi-organ failure with potential benefit on neuroprotection and outcome. The study is a phase II multicenter prospective controlled open-label trial randomized in two parallel groups : * Expérimental group: Standard of care care for post-CA shock + Vitamin C (Vit-C) 200mg/kg/d IV (started as early as possible, no later than 1 h after randomization + thiamin (Vit B1) 200mg every 12 h during 3 days. * Control group: Standard of care care for post CA shock according international guidelines. Patient number to be enrolled : 234, Study duration :24 months and 28 days, Inclusion duration : 24 months, Patient participation : duration : 28 days

Interventions

• Drug Vitamin C (Laroscorbine) + Vitamin B1 (Bevitine)
  in addition of standard post-CA as the control group, patients will receive an IV high-dose vit-C 50mg/kg infusion every 6 hours, started within the hour after randomization, for 3 days. In addition, all patients will receive intravenous thiamine 200 mg twice a day for 3 days to limit the oxalate production.
• Drug standard treatment
  no intervention Standard IV vit-C supplementation will be allowed for dosages up to 1000 mg a day from day 4 after randomization, as well as thiamin supplementation.

Primary outcome measures

• Cumulative incidence of weaning from vasopressors at day 3 after OHCA. [Time frame: day 3]

Secondary outcome measures (5)

• Cumulative incidence of death by refractory shock within 7 days after OHCA. [Time frame: day 7 after OHCA]
• the neurological outcome at day 28 after OHCA, with mRS range from 0 to 3. [Time frame: day 28 after OHCA]
• The maximal vasopressors infusion dose within 3 days after OHCA. [Time frame: 72 hours after OHCA]
• The delta SOFA (sepsis-related organ failure assessment score) is defined as the difference between SOFA admission and SOFA at 72 hours after OHCA. [Time frame: 72 hours after OHCA]
• The lower arterial lactate level at day 3 after OHCA. [Time frame: 72 hours after OHCA]

Eligibility criteria

Inclusion criteria

• patients still comatose (Glasgow coma scale < 8) after an OHCA of presumed cardiac origin with ROSC < 60 min;
• and treated with a norepinephrin or an epinephrin continuous infusion during at least 30 min before randomization to maintain mean arterial pressure (MAP) ≥ 65 mmHg.

Exclusion criteria

• patients still comatose (Glasgow coma scale < 8) after an OHCA of presumed cardiac origin with ROSC < 60 min;
• and treated with a norepinephrin or an epinephrin continuous infusion ≥ 0.2µg/kg/h, within 4 hours after OHCA, during at least 30 min/h to maintain mean arterial pressure (MAP) ≥ 65 mmHg.

Exclusion criteria

• minor or pregnant women;
• OHCA from evident extracardiac cause (trauma, bleeding, poisoning, etc.);
• interval between RACS and randomization > 6 hours;
• extracorporeal circulatory assistance requirement in the first 4 hours after OHCA;
• history of urolithiasis, oxalate nephropathy or hemochromatosis;
• glucose-6-phosphate deshydrogenase deficiency; nephrolithiasis, hyperoxalyurie
• patients already treated with vit-C; known vit-C deficit;
• inclusion in another study;
• pre-existent severe chronic kidney disease (glomerular filtration rate < 30ml/min);
• treatment limitationsor moribound
• Patient with derpived freedom or with legal protective measures.
• Patient not covered by French national health insurance

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

France · 14 centers

• Centre Hospitalier Universitaire d'Amiens — Amiens
• CH d'Arras — Arras
• Centre Hospitalier Béthune — Béthune
• CHI Nord-Ardennes — Charleville-Mézières
• Centre Hospitalier de Dieppe — Dieppe
• GHEF Site Marne La Vallée — Jossigny
• Centre Hospitalier de LENS — Lens
• Centre Hospitalier Universitaire de LILLE — Lille
• … and 6 more centers

Publications

• Chelly J, Peres N, Sboui G, Maizel J, Beuzelin M, Nigeon O, Preau S, Vong LVP, Tamion F, Lambiotte F, Deye N, Bertrand T, Behal H, Ducros L, Vinsonneau C. Early intravenous high-dose vitamin C in postcardiac arrest shock (VICEPAC): study protocol for a randomised, single-blind, open-label, multicentre, controlled trial. BMJ Open. 2024 Sep 24;14(9):e087303. doi: 10.1136/bmjopen-2024-087303. PMID 39317492

Identifiers

NCT: NCT05817851 · 2022-01

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗