Trial Outcomes & Findings for Esmolol to Treat the Hemodynamic Effects of Septic Shock (NCT NCT02369900)

NCT ID: NCT02369900

Last Updated: 2021-06-28

Results Overview

The primary endpoint will be mean norepinephrine equivalent dose (mcg/kg/min) at 6 hours after onset of study drug. For the vasopressor vasopressin, the dose of vasopressin was multiplied by 2.5 in order to create a norepinephrine equivalent dose. For the vasopressor phenylephrine, the dose of phenylephrine was divided by 10 in order to create a norepinephrine equivalent dose.

Recruitment status

TERMINATED

Study phase

PHASE2

Target enrollment

40 participants

Primary outcome timeframe

6 hours

Results posted on

2021-06-28

Participant Flow

Participant milestones

Participant milestones
Measure
Esmolol Infusion
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Overall Study
STARTED
18
22
Overall Study
COMPLETED
18
22
Overall Study
NOT COMPLETED
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Esmolol to Treat the Hemodynamic Effects of Septic Shock

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Total
n=40 Participants
Total of all reporting groups
Ethnicity (NIH/OMB)
Not Hispanic or Latino
13 Participants
n=99 Participants
18 Participants
n=107 Participants
31 Participants
n=206 Participants
Age, Categorical
<=18 years
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Age, Categorical
Between 18 and 65 years
10 Participants
n=99 Participants
14 Participants
n=107 Participants
24 Participants
n=206 Participants
Age, Categorical
>=65 years
8 Participants
n=99 Participants
8 Participants
n=107 Participants
16 Participants
n=206 Participants
Age, Continuous
64 years
n=99 Participants
62 years
n=107 Participants
63 years
n=206 Participants
Sex: Female, Male
Female
8 Participants
n=99 Participants
9 Participants
n=107 Participants
17 Participants
n=206 Participants
Sex: Female, Male
Male
10 Participants
n=99 Participants
13 Participants
n=107 Participants
23 Participants
n=206 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants
n=99 Participants
0 Participants
n=107 Participants
1 Participants
n=206 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
4 Participants
n=99 Participants
4 Participants
n=107 Participants
8 Participants
n=206 Participants
Region of Enrollment
United States
18 participants
n=99 Participants
22 participants
n=107 Participants
40 participants
n=206 Participants

PRIMARY outcome

Timeframe: 6 hours

The primary endpoint will be mean norepinephrine equivalent dose (mcg/kg/min) at 6 hours after onset of study drug. For the vasopressor vasopressin, the dose of vasopressin was multiplied by 2.5 in order to create a norepinephrine equivalent dose. For the vasopressor phenylephrine, the dose of phenylephrine was divided by 10 in order to create a norepinephrine equivalent dose.

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Need for Vasopressor Support, Measured as Mean Norepinephrine Equivalent Dose (mcg/kg/Min), at 6hr Time Point
0.30 mcg/kg/min
Standard Deviation 0.17
0.21 mcg/kg/min
Standard Deviation 0.19

SECONDARY outcome

Timeframe: 12 and 24 hours

While the primary endpoint will be mean norepinephrine dose at 6h, we will also measure mean vasopressor dose in groups at 12h and 24h.

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Overall Need for Vasopressor Support
12 hours
0.31 mcg/kg/min
Standard Deviation 0.19
0.17 mcg/kg/min
Standard Deviation 0.17
Overall Need for Vasopressor Support
24 hours
0.24 mcg/kg/min
Standard Deviation 0.19
0.16 mcg/kg/min
Standard Deviation 0.17

SECONDARY outcome

Timeframe: 6 and 12 hours

We will measure median heart rate at the 6 and 12h time points.

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Heart Rates Between Groups
6 hours
92 beats per minutes
Interval 89.0 to 104.0
98 beats per minutes
Interval 89.0 to 110.0
Heart Rates Between Groups
12 hours
89 beats per minutes
Interval 79.0 to 105.0
96 beats per minutes
Interval 85.0 to 105.0

SECONDARY outcome

Timeframe: Duration of hospitalization, limit 180 days

Time to shock reversal (cessation of all vasopressors for at least 12h).

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Time to Shock Reversal
3.9 days
Interval 1.9 to 6.5
2.5 days
Interval 1.5 to 6.1

SECONDARY outcome

Timeframe: 6, 12, and 24 hours

Population: One patient in the standard care group was missing lactate levels at 6, 12, and 24 hours and one patient in the standard care group was missing a lactate level at 24 hours.

Median percent change from baseline lactate measured at the 6, 12, and 24 hour time points after study initiation between groups. Percent change was calculated by subtracting the later lactate from the baseline lactate and dividing the difference by the baseline lactate (i.e. (baseline lactate - 6h lactate)/baseline lactate).

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=21 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Lactate
6 hours
16.7 percent change from baseline
Interval 2.7 to 22.2
0 percent change from baseline
Interval -21.4 to 19.3
Lactate
12 hours
27.5 percent change from baseline
Interval 4.3 to 37.9
8.8 percent change from baseline
Interval -5.3 to 35.3
Lactate
24 hours
30.4 percent change from baseline
Interval 12.1 to 50.0
19.1 percent change from baseline
Interval -18.2 to 37.1

SECONDARY outcome

Timeframe: 12 and 24 hours

Population: Only patients on mechanical ventilation who were able to be attached to the VO2 machine and had data within the first 24 hours were included.

To analyze the difference in oxygen consumption between groups at 12 hours, 24 hours and over time for patients who were on mechanical ventilation at enrollment, VO2 measurements were compared (standardized by bodyweight in kilograms) over time (recorded every minute from the time of study drug administration over a period of at least 24 hours) between groups using mixed linear model accounting for repeated measures. Using an unadjusted model, mean differences at 12 hours, 24 hours and for differences in the overall trend over time were tested.

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=6 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=9 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Oxygen Consumption (VO2)
12 hours
3.78 mL/kg/min
Interval 3.09 to 4.21
4.29 mL/kg/min
Interval 3.27 to 4.82
Oxygen Consumption (VO2)
24 hours
4.13 mL/kg/min
Interval 2.74 to 6.32
4.83 mL/kg/min
Interval 2.63 to 9.19

SECONDARY outcome

Timeframe: 12 and 24 hours

Population: Blood was not able to be drawn from all patients at all time points.

To characterize effects of esmolol on inflammatory markers in patients with vasopressor-dependent septic shock, we compared log-transformed values of interleukin-4 at 12 and 24 hours and over time between groups using mixed linear model accounting for repeated measures and adjusting for pre-intervention levels.

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Interleukin-4
12 hours
0.027 pg/mL
Interval 0.007 to 0.096
0.023 pg/mL
Interval 0.018 to 0.069
Interleukin-4
24 hours
0.016 pg/mL
Interval 0.008 to 0.067
0.018 pg/mL
Interval 0.011 to 0.086

SECONDARY outcome

Timeframe: 12 and 24 hours

Population: Blood was not able to be drawn from all patients at all time points.

To characterize effects of esmolol on inflammatory markers in patients with vasopressor-dependent septic shock, we compared log-transformed values of interleukin-6 at 12 and 24 hours and over time between groups using mixed linear model accounting for repeated measures and adjusting for pre-intervention levels.

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Interleukin-6
12 hours
62.3 pg/mL
Interval 22.5 to 190.5
78.3 pg/mL
Interval 45.8 to 153.4
Interleukin-6
24 hours
54.4 pg/mL
Interval 18.1 to 242.4
39.0 pg/mL
Interval 16.5 to 118.9

SECONDARY outcome

Timeframe: 12 and 24 hours

Population: Blood was not able to be drawn from all patients at all time points.

To characterize effects of esmolol on inflammatory markers in patients with vasopressor-dependent septic shock, we compared log-transformed values of interleukin-10 at 12 and 24 hours and over time between groups using mixed linear model accounting for repeated measures and adjusting for pre-intervention levels.

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Interleukin-10
12 hours
3.5 pg/mL
Interval 2.2 to 8.6
5.4 pg/mL
Interval 1.9 to 13.0
Interleukin-10
24 hours
3.4 pg/mL
Interval 1.7 to 7.1
2.8 pg/mL
Interval 1.4 to 6.0

SECONDARY outcome

Timeframe: 12 and 24 hours

Population: Blood was not able to be drawn from all patients at all time points.

To characterize effects of esmolol on inflammatory markers in patients with vasopressor-dependent septic shock, we compared log-transformed values of TNF-alpha at 12 and 24 hours and over time between groups using mixed linear model accounting for repeated measures and adjusting for pre-intervention levels.

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
TNF-alpha
12 hours
4.5 pg/mL
Interval 2.3 to 8.9
8.7 pg/mL
Interval 4.6 to 16.5
TNF-alpha
24 hours
4.4 pg/mL
Interval 2.8 to 6.9
7.5 pg/mL
Interval 4.9 to 12.9

SECONDARY outcome

Timeframe: 12 and 24 hours

Population: Blood was not able to be drawn from all patients.

To characterize effects of esmolol on inflammatory markers in patients with vasopressor-dependent septic shock, we compared log-transformed values of C-reactive protein at 12 and 24 hours and over time between groups using mixed linear model accounting for repeated measures and adjusting for pre-intervention levels.

Outcome measures

Outcome measures
Measure
Esmolol Infusion
n=18 Participants
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 Participants
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
C-reactive Protein
12 hours
140.5 pg/mL
Interval 101.8 to 191.8
170.2 pg/mL
Interval 87.8 to 244.6
C-reactive Protein
24 hours
155.2 pg/mL
Interval 74.0 to 201.8
189.7 pg/mL
Interval 105.4 to 217.5

Adverse Events

Esmolol Infusion

Serious events: 4 serious events
Other events: 0 other events
Deaths: 6 deaths

Standard Care, Saline

Serious events: 0 serious events
Other events: 0 other events
Deaths: 8 deaths

Serious adverse events

Serious adverse events
Measure
Esmolol Infusion
n=18 participants at risk
Esmolol infusion for 24 hours. Esmolol will be titrated to a heart rate of 80 - 94 per minute, starting at 10mcg/kg/min and subsequently increasing every 20 minutes in increments of 10 mcg/kg/min (or slower at the discretion of the team) until target is achieved. The maximum allowed dose will be 300mcg/kg/min. Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Esmolol
Standard Care, Saline
n=22 participants at risk
Standard care (no esmolol). Patients, irrespective of treatment group, will be managed at the discretion of the clinical team. BIDMC has internal guidelines for the management of septic shock which reflect the most recent 2012 Surviving Sepsis Campaign guidelines and are incorporated into the care of patients with septic shock in the ICUs Saline
Cardiac disorders
Decrease in Cardiac Index
22.2%
4/18 • Number of events 4 • 24 hours
0.00%
0/22 • 24 hours
Cardiac disorders
Abnormal Heart Rhythym
5.6%
1/18 • Number of events 1 • 24 hours
0.00%
0/22 • 24 hours
General disorders
PEA arrest
5.6%
1/18 • Number of events 1 • 24 hours
0.00%
0/22 • 24 hours

Other adverse events

Adverse event data not reported

Additional Information

Michael N. Cocchi MD

Beth Israel Deaconess Medical Center

Phone: 617-754-2388

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place