Detail Article

Informations générales (source: ClinicalTrials.gov)

Numéro NCT

NCT04184635 En recrutement IDF

Titre

Assessment of ECMO in Acute Myocardial Infarction With Non-reversible Cardiogenic Shock to Halt Organ Failure and Reduce Mortality (ANCHOR)

Type

Interventional

Pathologie

Infarctus
Infarctus du myocarde
Choc
Choc cardiogénique

Phase

N/A

Promoteur

Assistance Publique - Hôpitaux de Paris (Voir sur ClinicalTrials)

Date de début

octobre 2021

Date de fin

octobre 2027

Dernière mise à jour

14 septembre 2025

Résumé

Data from case series and large retrospective trials suggest that the early treatment of cardiogenic shock AMI patients with the association of VA-ECMO and IABP may significantly decrease mortality, which is still unacceptably high nowadays (40-50% at 30 days). An important benefit for the patients randomized to the ECMO arm is expected and the risk-to-benefit ratio is expected to be in favor of the experimental treatment arm.

Détail

Voir le détail Scientific background - Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used more and more frequently in patients with acute myocardial infarction (AMI) and refractory cardiogenic shock despite the absence of high level scientific evidence to recommend the use of temporary circulatory support devices (TCS) in this setting.TCS support may also benefit to cardiogenic shock patients not initially refractory to conventional medical management since their mortality exceeds 40% and most of deaths are due to the development of refractory cardiogenic shock and multiple organ failure. The ANCHOR trial is therefore designed to test the hypothesis that VA-ECMO support associated with IABP results in improved outcomes in comparison with optimal medical treatment alone in patients with AMI and cardiogenic shock. An ethical rescue option to VA-ECMO will however be provided to control patients with cardiogenic shock refractory to conventional medical treatment since recent data suggested survival up-to 50% with ECMO support in this setting. Main objective - To determine if early VA-ECMO combined with IABP support and optimal medical treatment would improve the outcomes of patients with acute myocardial infarction complicated by cardiogenic shock as compared with optimal medical treatment alone. Scope of the study - Patients satisfying all of the Inclusion and Exclusion Criteria will be classified as 'Eligible'. Consent to research will be obtained from a close relative or surrogate for all eligible patients prior to randomization. Should such a person be absent, eligible patients will be randomized according to the specifications of emergency consent and the patient will be asked to give his/her consent for the continuation of the trial when his/her condition will allow. Randomization will be possible in centers with robust experience in the management of AMI and cardiogenic shock but no on-site ECMO capability providing that an ECMO retrieval team from the nearest ECMO center can establish ECMO no later than 2 hours after randomization. Before randomization, physicians at the non-ECMO center will check that the ECMO team is immediately available and that an ICU/CCU bed is available at the ECMO center. Thereafter, if the patient is randomized to the ECMO arm, the mobile ECMO retrieval team will travel to the center, initiate VA-ECMO and will rapidly transfer the patient on VA-ECMO to the ECMO center. Description of experimental ECMO + IABP Arm - Protocolized conventional management of cardiogenic shock - VA-ECMO will be started as soon as possible - For patients randomized at non-ECMO centers, a mobile ECMO team will initiate ECMO at the non-ECMO center and transport the patient to the ECMO center immediately - IABP inserted in the contralateral femoral artery (unless technically not possible) - ECMO management according to protocol - ECMO weaning according to protocol Description of conventional treatment Arm - Protocolized conventional management of cardiogenic shock - IABP not recommended. No other TCS device (e.g., ECMO, Impella, Thoratec PHP, TandemHeart) permitted - Rescue VA-ECMO only if one of 1 or 2 or 3 applies: - 1. Refractory cardiogenic shock defined as 1. Cardiac index <1.2 l/min/m² or VTI <6 cm AND 2. Assessment and correction of hypovolemia AND 3. (dobutamine ≥15 microg/kg/min + norepinephrine ≥1.5 microg/kg/min) OR epinephrine ≥ 0.75 microg/kg/min 4. Serum lactate >5 mmol/L or serum lactate increased >50% in the last 6 hours - 2. Uncontrolled lethal arrhythmia despite K >4.5 mmol/l AND Mg >1.0 mmol/l AND Intubation and mechanical ventilation with deep sedation AND IV Loading of amiodarone AND IV xylocaine - 3. Refractory cardiac arrest Mandatory validation of rescue VA-ECMO by an independent adjudicator. Fermer le détail

Etablissements

Les établissements d'Île-de-France ayant mis à jour leurs données Origine et niveau de fiabilité des données
CENTRE CARDIOLOGIQUE D EVECQUEMONT	COMBES Alain	En recrutement IDF	01/11/2025 08:10:27	Contacter
CENTRE CARDIOLOGIQUE DU NORD	COMBES Alain	En recrutement IDF	01/11/2025 08:10:28	Contacter
CENTRE HOSPITALIER SUD FRANCILIEN	COMBES Alain	En recrutement IDF	01/11/2025 08:10:27	Contacter
CH DE VERSAILLES SITE ANDRE MIGNOT	COMBES Alain	En recrutement IDF	01/11/2025 08:10:27	Contacter
CH GENERAL DE GONESSE	COMBES Alain	En recrutement IDF	01/11/2025 08:10:29	Contacter
CHI ANDRE GREGOIRE	COMBES Alain	En recrutement IDF	01/11/2025 08:10:28	Contacter
CHI LUCIE ET RAYMOND AUBRAC	COMBES Alain	En recrutement IDF	01/11/2025 08:10:29	Contacter
CHI POISSY ST-GERMAIN	COMBES Alain	En recrutement IDF	01/11/2025 08:10:26	Contacter
GH PARIS SITE SAINT JOSEPH	COMBES Alain	En recrutement IDF	01/11/2025 08:10:26	Contacter
GHI LE RAINCY MONTFERMEIL	COMBES Alain	En recrutement IDF	01/11/2025 08:10:28	Contacter
GRAND HOPITAL DE L'EST FRANCILIEN	COMBES Alain	En recrutement IDF	01/11/2025 08:10:26	Contacter
HOPITAL FOCH	COMBES Alain	En recrutement IDF	01/11/2025 08:10:28	Contacter
HOPITAL NOVO	COMBES Alain	En recrutement IDF	01/11/2025 08:10:29	Contacter
HOPITAL PRIVE D ANTONY	COMBES Alain	En recrutement IDF	01/11/2025 08:10:28	Contacter
HOPITAL PRIVE JACQUES CARTIER	COMBES Alain	En recrutement IDF	01/11/2025 08:10:27	Contacter
INSTITUT MUTUALISTE MONTSOURIS	COMBES Alain	En recrutement IDF	01/11/2025 08:10:26	Contacter
AP-HP Assistance publique - Hôpitaux de Paris		En recrutement IDF	01/11/2025 08:10:31	Contacter
	AP-HP - Hôpital Ambroise Paré
	AP-HP - Hôpital Bicêtre
	AP-HP - Hôpital Bichat
	AP-HP - Hôpital Cochin
	AP-HP - Hôpital Europeen Georges Pompidou
	AP-HP - Hôpital Henri Mondor-Albert Chenevier
	AP-HP - Hôpital La Pitié-Salpêtrière
	AP-HP - Hôpital Lariboisiere-Fernand Widal
Les établissements sans correspondance certaine dans le répertoire FINESS dont les données sont issues de ClinicalTrials.gov Origine et niveau de fiabilité des données
Hôpital Pitié Salpétrière - 75013 - Paris - France	ALAIN COMBES, MD	En recrutement		Contact (sur clinicalTrials)

Critères

Genre

Tous

Nombre d'inclusion

Critère d'inclusion

Inclusion Criteria:

- Cardiogenic shock complicating acute myocardial infarction (STEMI or NSTEMI)

- Revascularization by PCI for acute myocardial infarction has been performed or is
planned in the following 60 minutes

- Systolic blood pressure <90 mmHg for >30 min or catecholamine support required to
maintain systolic blood pressure >90 mmHg

- Signs of pulmonary congestion

- Signs of impaired organ perfusion with at least one of the following:

Altered mental status OR cold, clammy skin and extremities OR oliguria with urine output
<30 ml/h OR serum lactate >2.0 mmol/l

Critère de non inclusion

- Age <18 years

- Pregnancy

- Onset of shock >24 Hours

- Shock of other cause (hypovolemic, anaphylactic or vagal shock)

- Shock due to massive pulmonary embolism

- Resuscitation >30 minutes

- No intrinsic heart activity

- Patient moribund on the day of randomization or SAPS II >90

- Surgical revascularization for AMI (CABG) planned or already performed prior to
randomization

- Cerebral deficit with fixed dilated pupils or Irreversible neurological pathology

- Mechanical infarction complication (massive mitral regurgitation, pericardium
drainage required, septal ventricular defect)

- Severe peripheral artery disease or previous aortic or ilio-femoral surgery
precluding ECMO and IABP insertion

- Aortic regurgitation > II

- Other severe concomitant disease with limited life expectancy < 1 year

- Proven heparin-induced thrombocytopenia

- ECMO device not immediately available

NCT04184635 - Assessment of ECMO in Acute Myocardial Infarction With Non-reversible Cardiogenic Shock to Halt Organ Failure and Reduce Mortality (ANCHOR)

Informations générales
Etablissements
Critères
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