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    Clinical Trial Results:
    Prevention of early ventilator-associated pneumonia with antibiotic therapy in patients treated with mild therapeutic hypothermia after cardiac arrest. Randomized, multicenter double-blind placebo-controlled trial.

    Summary
    EudraCT number
    2014-000202-35
    Trial protocol
    FR  
    Global end of trial date
    14 Sep 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    27 May 2021
    First version publication date
    27 May 2021
    Other versions
    Summary report(s)
    Summary results

    Trial information

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    Trial identification
    Sponsor protocol code
    I13018
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02186951
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Limoges University Hospital
    Sponsor organisation address
    2 avenue Martin Luther King, LIMOGES, France, 87042
    Public contact
    Directeur Recherche et innovation, CHU de LIMOGES, +33 555056349, drc@chu-limoges.fr
    Scientific contact
    Directeur Recherche et innovation, CHU de LIMOGES, +33 555056349, drc@chu-limoges.fr
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Interim
    Date of interim/final analysis
    19 Dec 2017
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    27 Oct 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    14 Sep 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Incidence reduction of early VAP with short term amoxicillin-clavulanic acid in patients treated with hypothermia after out-of-hospital cardiac arrest
    Protection of trial subjects
    NA
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    18 Aug 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    France: 194
    Worldwide total number of subjects
    194
    EEA total number of subjects
    194
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    121
    From 65 to 84 years
    69
    85 years and over
    4

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    No pre-assignment period

    Period 1
    Period 1 title
    overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Augmentin
    Arm description
    Amoxicillin-clavulanic acid 1g, three times a day during 2 days, started within one hour after randomization and before the beginning of hypothermia.
    Arm type
    Experimental

    Investigational medicinal product name
    Amoxicilline/Acide Clavulanique
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    6g total

    Arm title
    Placebo
    Arm description
    Placebo 1g, three times a day during 2 days, started within one hour after randomization and before the beginning of hypothermia.
    Arm type
    Placebo

    Investigational medicinal product name
    Chlorure de sodium
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    The sodium chloride was prepared at the moment of the injection, or maximum 15 minutes before. The sodium chloride was administered as a slow intravenous injection over a period of 3 to 4 minutes.

    Number of subjects in period 1
    Augmentin Placebo
    Started
    99
    95
    Completed
    99
    95

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Augmentin
    Reporting group description
    Amoxicillin-clavulanic acid 1g, three times a day during 2 days, started within one hour after randomization and before the beginning of hypothermia.

    Reporting group title
    Placebo
    Reporting group description
    Placebo 1g, three times a day during 2 days, started within one hour after randomization and before the beginning of hypothermia.

    Reporting group values
    Augmentin Placebo Total
    Number of subjects
    99 95 194
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    61 60 121
        From 65-84 years
    37 32 69
        85 years and over
    1 3 4
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    60.6 ( 14.3 ) 60.3 ( 14.6 ) -
    Gender categorical
    Units: Subjects
        Female
    76 80 156
        Male
    23 15 38
    Subject analysis sets

    Subject analysis set title
    all patients
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Patients randomized and treated

    Subject analysis sets values
    all patients
    Number of subjects
    194
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    121
        From 65-84 years
    69
        85 years and over
    4
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    60.5 ( 14.4 )
    Gender categorical
    Units: Subjects
        Female
    38
        Male
    156

    End points

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    End points reporting groups
    Reporting group title
    Augmentin
    Reporting group description
    Amoxicillin-clavulanic acid 1g, three times a day during 2 days, started within one hour after randomization and before the beginning of hypothermia.

    Reporting group title
    Placebo
    Reporting group description
    Placebo 1g, three times a day during 2 days, started within one hour after randomization and before the beginning of hypothermia.

    Subject analysis set title
    all patients
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Patients randomized and treated

    Primary: Incidence reduction of early VAP

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    End point title
    Incidence reduction of early VAP [1]
    End point description
    Incidence reduction of early VAP with short term amoxicillin-clavulanic acid in patients treated with hypothermia after out-of-hospital cardiac arrest
    End point type
    Primary
    End point timeframe
    7 days
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: See publication attached
    End point values
    Augmentin Placebo
    Number of subjects analysed
    99
    95
    Units: number of early VAP
        number (not applicable)
    19
    32
    No statistical analyses for this end point

    Secondary: Mortality

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    End point title
    Mortality
    End point description
    Mortality
    End point type
    Secondary
    End point timeframe
    28 days
    End point values
    Augmentin Placebo
    Number of subjects analysed
    99
    95
    Units: number
        number (not applicable)
    41
    35
    No statistical analyses for this end point

    Secondary: Infections nosocomiales autres que PAVM

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    End point title
    Infections nosocomiales autres que PAVM
    End point description
    End point type
    Secondary
    End point timeframe
    28 days
    End point values
    Augmentin Placebo
    Number of subjects analysed
    99
    95
    Units: number
        number (not applicable)
    7
    8
    No statistical analyses for this end point

    Secondary: Late PAVM

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    End point title
    Late PAVM
    End point description
    End point type
    Secondary
    End point timeframe
    28 days
    End point values
    Augmentin Placebo
    Number of subjects analysed
    99
    95
    Units: number
        number (not applicable)
    4
    5
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    overall study
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.1
    Reporting groups
    Reporting group title
    all patients
    Reporting group description
    -

    Serious adverse events
    all patients
    Total subjects affected by serious adverse events
         subjects affected / exposed
    93 / 194 (47.94%)
         number of deaths (all causes)
    86
         number of deaths resulting from adverse events
    Injury, poisoning and procedural complications
    delayed waking-up
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Vascular disorders
    refractory shock
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Surgical and medical procedures
    Eventration repair
    alternative dictionary used: MedDRA 19.1
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Cardiac arrest
         subjects affected / exposed
    5 / 194 (2.58%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 4
    Cardio-respiratory arrest
         subjects affected / exposed
    5 / 194 (2.58%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 3
    Sinus arrest
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiogenic shock
         subjects affected / exposed
    5 / 194 (2.58%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 5
    Atrial fibrillation
         subjects affected / exposed
    2 / 194 (1.03%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Myocardial infarction
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mitral insufficiency
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Myocardial ischaemia
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Cerebrovascular accident
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    brain damage
         subjects affected / exposed
    2 / 194 (1.03%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    Coma
         subjects affected / exposed
    8 / 194 (4.12%)
         occurrences causally related to treatment / all
    0 / 8
         deaths causally related to treatment / all
    0 / 8
    Encephalopathy
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    anoxic encephalopathy
         subjects affected / exposed
    26 / 194 (13.40%)
         occurrences causally related to treatment / all
    0 / 26
         deaths causally related to treatment / all
    0 / 26
    Status epilepticus
         subjects affected / exposed
    3 / 194 (1.55%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 2
    hypoxia cerebral
         subjects affected / exposed
    13 / 194 (6.70%)
         occurrences causally related to treatment / all
    0 / 13
         deaths causally related to treatment / all
    0 / 13
    cerebral lesion
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    cerebral oedema
         subjects affected / exposed
    2 / 194 (1.03%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    Syncope
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Heparin-induced thrombocytopenia
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    multi-organ failure
         subjects affected / exposed
    8 / 194 (4.12%)
         occurrences causally related to treatment / all
    0 / 8
         deaths causally related to treatment / all
    0 / 8
    thoracic pain
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    cerebrel death
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Gastrointestinal disorders
    Colitis ischaemic
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Atelectasis
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Respiratory failure
         subjects affected / exposed
    2 / 194 (1.03%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Respiratory distress
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    ventilator associated pneumonia
         subjects affected / exposed
    5 / 194 (2.58%)
         occurrences causally related to treatment / all
    0 / 6
         deaths causally related to treatment / all
    0 / 3
    Renal and urinary disorders
    Renal failure
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Psychiatric disorders
    Delirium
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Tracheobronchitis
         subjects affected / exposed
    1 / 194 (0.52%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Septic shock
         subjects affected / exposed
    2 / 194 (1.03%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    all patients
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    49 / 194 (25.26%)
    Respiratory, thoracic and mediastinal disorders
    ventilator associated pneumonia
         subjects affected / exposed
    36 / 194 (18.56%)
         occurrences all number
    38
    aspiration pneumonia
         subjects affected / exposed
    13 / 194 (6.70%)
         occurrences all number
    13

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    12 Sep 2014
    Addition of e secondary objective, modification of patient participation duration, addition of supplementary analyses in microbiot study and addition of exclusion criteria
    07 May 2015
    prolongation of inclusion period for 12 months
    22 Sep 2016
    Increasing of inclusion number

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/31693806
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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