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PTSDSGB-PsychoEDNCT04582396

Stellate Ganglion Blockade to Reduce Cardiac Anxiety and PTSD Symptoms in Cardiac Arrest Survivors

A study testing stellate ganglion block injection, Normal saline injection and Psychoeducation in people with PTSD and Cardiac Arrest, run by Columbia University at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This is a pilot randomized controlled trial (RCT) to gain preliminary evidence regarding the acceptability, tolerability, safety, and efficacy of a combined intervention of Stellate Ganglion Blockade (SGB) and psychoeducation on trauma symptoms and health behaviors in patients exhibiting early PTSD symptoms after… Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
PTSD, Cardiac Arrest, Anxiety and Fear
What is being tested?
stellate ganglion block injection, Normal saline injection and Psychoeducation
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
1 participants
Where
1 siteUnited States
Study dates
11 Mar 2021to 19 Apr 2021
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18 years or older
  • Fluent in English or Spanish
  • A diagnosis of cardiac arrest (CA)
  • Admitted to the New York-Presbyterian Hospital
  • Elevated symptoms of psychological distress a. PCL-5 > 32 with a minimum of 2 weeks after cardiac arrest

Who cannot join

  • A prior SGB treatment
  • Severe brain injury defined as Cerebral Performance Category Score ≥3, and/or significant aphasia, dysarthria, or cognitive impairment precluding ability to complete study questionnaires as determined by interviewer
  • Terminal non-cardiovascular illness (life expectancy <1 year)
  • Severe mental illness requiring urgent psychiatric hospitalization
  • Alcohol or substance abuse that would impede ability to complete study
  • Unavailable for telephone and in-person follow-up
Show all 12Show fewer
  • Allergy to amide local anesthetics (e.g., ropivacaine, bupivacaine)
  • Pre-existing Horner's syndrome
  • Pregnancy
  • Current anticoagulant use
  • History of a bleeding disorder
  • Infection or mass at injection site

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Columbia University Medical Center/New York Presbyterian

    New York, New York, 10032

Other trials in United States

About this study

Official title: A Pilot Study of Stellate Ganglion Blockade + Psychoeducation to Reduce Cardiac Anxiety and PTSD Symptoms in Cardiac Arrest Survivors

This is a pilot randomized controlled trial (RCT) to gain preliminary evidence regarding the acceptability, tolerability, safety, and efficacy of a combined intervention of Stellate Ganglion Blockade (SGB) and psychoeducation on trauma symptoms and health behaviors in patients exhibiting early PTSD symptoms after cardiac arrest (CA).

Primary Aim 1 (Feasibility outcomes): Gain preliminary evidence regarding the acceptability, tolerability, and safety of conducting a randomized trial that evaluates a single SGB treatment in conjunction with psychoeducation among CA patients with early PTSD symptoms.

Secondary Aim 1 (Treatment-related outcomes): Test, whether SGB/psychoeducation treatment in CA patients with clinically significant PTSD symptoms is associated with reduced cardiac anxiety, PTSD symptoms, and improved health behaviors (physical activity and sleep duration), assessed objectively by a wrist-worn accelerometer for 4 weeks post-discharge.

Read the detailed description

Every year in the U.S., 500,000 people experience sudden cardiac arrest (CA), caused by electrical disturbances across cardiac tissue, leading to marked arrhythmia that ultimately results in the heart ceasing to pump blood to the brain, lungs, and other organs. Due to advances in bundled post-arrest care, cardio-cerebral resuscitation, and effective cooling protocols, a substantial proportion of patients who receive guideline-based care (nearly 1 in 3 for out-of-hospital and ~50% for in-hospital CA) now survive this once universally fatal condition. While most survivors retain their cognitive function and physical independence, many grapple with CA's psychological consequences in the context of learning that they were "clinically dead."

In particular, many describe the CA experience as traumatic, and up to 1 in 3 CA survivors subsequently develop posttraumatic stress disorder (PTSD). Not only is PTSD common in CA patients, but there is evidence that PTSD after CA may influence health behaviors and prognosis.

Treatment of early PTSD and cardiac anxiety symptoms after CA requires timely intervention. Recent studies show that SGB is a safe and acceptable intervention for reducing PTSD symptoms in combat veterans. SGB treatment has never been tested to treat PTSD induced by acute medical events such as CA.

Being tested
stellate ganglion block injection, Normal saline injection, Psychoeducation
Medical subject headings
Stress Disorders, Post-Traumatic, Heart Arrest, Anxiety Disorders, Parasomnias, Health Behavior

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • stellate ganglion block injectionProcedure or surgery

    Also called SGB injection

    A stellate ganglion block (SGB) is an injection of local anesthetic (numbing medicine) to block the nerves located on either side of the voice box in the neck. It will be administered in an inpatient monitored setting.

  • Normal saline injectionProcedure or surgery

    Also called Sham procedure

    An injection of normal saline will be injected into muscle on either side of the voice box in the neck. It will be administered in an inpatient monitored setting.

  • PsychoeducationBehavioural

    The session will be 30 minutes in duration, to be administered by a health professional with experience working with CA patients, the goal will be to establish rapport and help patient identify anxious situations, thoughts, and bodily feelings related their recent CA that could lead to avoidant behavior.

    Explain how many of these feelings are common in CA survivors, and they are often unrelated to their risk of its recurrence. Explain how the body has a fight-or-flight system that is controlled in part by the stellate ganglion and explain how blocking the action of this part of the body can reduce the feelings of anxiety that commonly occur. Discuss how certain activities such as exercise can increase feelings of anxiety around bodily sensations, but continued engagement could reduce that fear and that exercise is helpful for recovering from CA

Study groups in NCT04582396
Study groupRoleWhat they receive
Stellate Ganglion Block + PsychoeducationExperimentalFor the active SGB arm, 7 to 8 mL of ropivacaine, 0.5%, will be injected around and into the site of the ganglion once before the hospital discharge. They will also receive a 30 minutes session of psychoeducation by a health professional with experience working with CA patients.
Receives: Procedure: stellate ganglion block injection; Behavioral: Psychoeducation
Normal saline injection + PsychoeducationPlacebo comparatorFor the sham procedure, 1 to 2 mL of preservative-free normal saline will be injected into deep musculature in the neck. They will also receive a 30 minutes session of psychoeducation by a health professional with experience working with CA patients.
Receives: Procedure: Normal saline injection; Behavioral: Psychoeducation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of Eligible Subjects Who Get Enrolled in the Trial

    This is designed to measure the feasibility of successful enrollment.

    Measured: Baseline (pre-procedure)

  2. Number of Patients Recruited Per Month

    This is designed to measure the rate of enrollment, with <4 patients/month considered not meeting outcome

    Measured: Assessed at 10 Month from the beginning of enrollment

  3. Proportion of Participants Who Complete the 4-weeks Assessments

    This is designed to assess the short-term attrition and lost to follow-up up to 4 weeks post-enrollment.

    Measured: 4 weeks post-enrollment

  4. Proportion of Participants Who Complete the 12-weeks Assessments

    This is designed to assess the long-term attrition and lost to follow-up up to 12 weeks post-enrollment.

    Measured: 12-weeks post-procedure

  5. Horner's Syndrome

    Horner syndrome is a condition that affects the face and eye on one side of the body, being caused by a disrupted nerve pathway from the brain to the head and neck. This syndrome can be assessed through a visual exam, involving the observation of decreased pupil size, a drooping eyelid and decreased sweating on the affected side of the face.

    Measured: Immediately post-procedure

  6. Treatment Expectancy Eligibility Questionnaire

    This is a questionnaire that assesses the number of participants with credibility. Through this questionnaire, whether the participant will proceed through the study will be determined.

    Measured: Immediately post-procedure

  7. The Proportion of Participants Completing the Check-list of Various Components of Psychoeducation

    This is designed to assess the feasibility of administering psychoeducation, with >80% of the components in the checklist as a threshold for success.

    Measured: Assessed at baseline post-procedure

  8. Total Actigraph Wear Time

    the proportion of participants with >80% of the total actigraph wear time. It is designed to assess the acceptability of actigraphy

    Measured: Assessed at 4-weeks post-procedure

Secondary outcomes (6)
  1. Number of Participants With Posttraumatic Stress Disorder Using Posttraumatic Stress Disorder (PCL-5)

    This is a 20-item self-report measure that assesses symptoms of PTSD. Each item can be scored on a scale of 0-4, "Not at all" (0), "A little bit" (1), "Moderately" (2), "Quite a bit" (3), and "Extremely" (4) are the eligible responses. There are five clusters that are assessed: items 1-5, items 6-7, items 8-14, and items 15-20. Each of these sub-scores are summed to receive a score between 0-80; a higher score indicating a higher severity of PTSD symptoms. The cutoff score that is indicative of probable PTSD is 31-33.

    Measured: Assessed pre-procedure and then repeated at 4-weeks post-procedure

  2. The Proportion of Participants With Clinically Significant Symptoms of Cardiac Anxiety

    The effect of SGB-PsychoED intervention on cardiac anxiety will be assessed using cardiac anxiety questionnaire (CAQ).This is an 18-item questionnaire that assesses anxiety through three divided sub-scales: fear (items 10, 11, 13-18), avoidance (items 2, 5, 7, 9, 12), and attention (items 1, 3, 4, 6, 8). Each item is scored via the 5-point Likert scale: "Never" (0), "Rarely" (1). "Sometimes" (2), "Often" (3), and "Always" (4). Item responses are summed to receive a score between 0-72. Higher reported scores indicate a greater heart-focused anxiety.

    Measured: Assessed pre-procedure and then repeated at 4-weeks post-procedure

  3. The Proportion of Participants With Clinically Significant Symptoms of Generalized Anxiety Disorder.

    The effect of the intervention on generalized anxiety disorder will be assessed using the generalized anxiety disorder scale-7 (GAD-7). This is a 7-item scale that assesses the presence of generalized anxiety disorder. Responses can be given as "Not at all" (0), "Several days" (1), "More than half the days" (2), and "Nearly every day" (3). These scores can be summed to produce a score between 0 and 21. Scores between 0-4 indicate minimal anxiety, scores between 5-9 indicate mild anxiety, scores between 10-14 indicate moderate anxiety, and scores greater than 15 indicate severe anxiety.

    Measured: Assessed pre-procedure and then repeated at 4-weeks post-procedure

  4. The Proportion of Participants With Clinically Significant Symptoms of Depression.

    The effect of SGB-PsychoED intervention on depression will be assessed using the eight-item Patient Health Questionnaire depression scale (PHQ-8). This is an 8-item scale that assesses depression, with responses to each item being: "Not at all" (0), "Several days" (1), "More than half the days" (2), and "Nearly every day" (3). The sub-scores are summed to result in a score from 0-24. Higher scores indicate higher indication of depression. Scores that are reported as 10 or above are assessed to be showing symptoms of depression.

    Measured: Assessed pre-procedure and then repeated at 4-weeks post-procedure

  5. The Proportion of Participants With Moderate to High Levels of Physical Activity.

    Effect of SGB-PsychoED intervention on mean minutes/day of physical activity as measured by the objective actigraphy data

    Measured: Assessed at 4-weeks post-discharge

  6. The Proportion of Participants With Reduced Duration of Sleep.

    Effect of SGB-PsychoED intervention on mean hours/day of sleep as measured by the objective actigraphy data

    Measured: Assessed at 4-weeks post-discharge

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Oct 2020
  2. Study start11 Mar 2021
  3. Primary completion19 Apr 2021
  4. Study completion19 Apr 2021

Why it stopped: majority of the participants had exclusion criteria of anticoagulant use

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a pilot RCT to gain preliminary evidence regarding the acceptability, tolerability, safety, and efficacy of a combined intervention of Stellate Ganglion Blockade and psychoeducation vs sham-procedure and psychoeducation on trauma symptoms and health behaviors in patients exhibiting early PTSD symptoms after cardiac arrest.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
1 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04582396
Sponsor's protocol ID
AAAS8305
Other IDs
5P30AG064198-02
Acronym
SGB-PsychoED
Status last verified
Jul 2024
First submitted
5 Oct 2020
Last updated
31 Jul 2024
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: De-identified data will be made available upon request to the study principal investigator.

Questions about this trial

What is this clinical trial studying?

A study testing stellate ganglion block injection, Normal saline injection and Psychoeducation in people with PTSD and Cardiac Arrest, run by Columbia University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 31 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 31 Jul 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of Eligible Subjects Who Get Enrolled in the Trial (time frame: Baseline (pre-procedure)). The study lists 8 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Jul 2024.

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