Beta blocker use in traumatic brain injury based on the high-sensitive troponin status (BBTBBT): methodology and protocol implementation of a double-blind randomized controlled clinical trial

Trials

Mohammad Asim¹  Ayman El-Menyar²  Abdulnasser Alyafai³  Ruben Peralta⁴  Hassan Al-Thani⁴  Ahmed Abdel-Aziz Bahey⁴  Sandro Rizoli⁴  Husham Abdelrahman⁴  Talat Chughtai⁵ 

[1] Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH), PO Box 3050, Doha, Qatar;Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH), PO Box 3050, Doha, Qatar;Clinical Medicine, Weill Cornell Medical College, Doha, Qatar;Department of Surgery, Neurosurgery, HGH, Doha, Qatar;Department of Surgery, Trauma Surgery Section, HGH, Doha, Qatar;Department of Surgery, Trauma Surgery Section, HGH, Doha, Qatar;Department of Surgery, Qatar University, Doha, Qatar;

关键词: Traumatic brain injury;    Beta blocker;    High-sensitive troponin;    Randomized control trial;    Functional outcome;   

DOI  :  10.1186/s13063-021-05872-8

来源: Springer

【 摘 要 】

BackgroundBeta-adrenergic receptor blockers (BB) play an important role in the protection of organs that are susceptible for secondary injury due to stress-induced adrenergic surge. However, the use of BB in traumatic brain injury (TBI) patients is not yet the standard of care which necessitates clear scientific evidence to be used. The BBTBBT study aims to determine whether early administration of propranolol based on the high-sensitive troponin T(HsTnT) status will improve the outcome of TBI patients. We hypothesized that early propranolol use is effective in reducing 10- and 30-day mortality in TBI patients. Secondary outcomes will include correlation between serum biomarkers (troponin, epinephrine, cytokines, enolase, S100 calcium binding protein B) and the severity of injury and the impact of BB use on the duration of hospital stay and functional status at a 3-month period.MethodsThe BBTBBT study is a prospective, randomized, double-blinded, placebo-controlled three-arm trial of BB use in mild-to-severe TBI patients based on the HsTnT status. All enrolled patients will be tested for HsTnT at the first 4 and 6 h post-injury. Patients with positive HsTnT will receive BB if there is no contraindication (group 1). Patients with negative HsTnT will be randomized to receive either propranolol (group 2) or placebo (group 3). The time widow for receiving the study treatment is the first 24 h post-injury.DiscussionEarly BB use may reduce the catecholamine storm and subsequently the cascade of immune and inflammatory changes associated with TBI. HsTnT could be a useful fast diagnostic and prognostic tool in TBI patients. This study will be of great clinical interest to improve survival and functional outcomes of TBI patients.Trial registrationClinicalTrials.gov NCT04508244. Registered on 7 August 2020. Recruitment started on 29 December 2020 and is ongoing.

【 授权许可】

CC BY