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Treatment of Vasopressor-induced Ischemia With Botulinum Toxin A

This study has been terminated.
(Low accrual)
Information provided by (Responsible Party):
Duke University Identifier:
First received: November 29, 2011
Last updated: February 16, 2015
Last verified: February 2015
The goal of this project is to determine if performing a "chemical sympathectomy" by injecting botulinum toxin A in critically ill patients on vasopressors can treat digital ischemia. This is a prospective, non-randomized pilot study designed to demonstrate proof of concept. We propose to study patients in the intensive care units of Duke Hospital who, secondary to exposure to vasoactive medications used to maintain acceptable blood pressures, have developed signs and symptoms of digital ischemia. A paired T-test will be used to compare pre- and post-injection Laser Doppler measurements for the experimental hand. We will again use a paired t-test to compare the experimental hand against the contralateral control hand. There were no major adverse events reported by the product information sheet or in other related studies of Botox for digital ischemia.

Condition Intervention
Drug: Injection of botulinum toxin A

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Treatment of Vasopressor-induced Ischemia With Botulinum Toxin A

Resource links provided by NLM:

Further study details as provided by Duke University:

Primary Outcome Measures:
  • Perfusion (as Determined by Laser Doppler Measurements) [ Time Frame: 12 months ]
    A paired T-test will be used to compare pre- and post-injection Laser Doppler measurements for the experimental hand. We will again use a paired t-test to compare the experimental hand against the contralateral control hand. Results for the experimental and control groups will be plotted and displayed graphically as percent change in Doppler flow (y-axis) and time (x-axis).

Secondary Outcome Measures:
  • Digital Amputations [ Time Frame: 12 months ]
    The number of digits amputated in our patient cohort is a secondary endpoint of this study. We will use a paired t-test to compare the number of digital amputations in the control versus experimental group.

Enrollment: 2
Study Start Date: March 2012
Study Completion Date: April 2014
Primary Completion Date: April 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Botox injection
Use of botulinum toxin A to determine efficacy in treating vasopressor-induced digital ischemia
Drug: Injection of botulinum toxin A
One-time injection of 100 units of botulinum toxin into hand to perform full chemical digital sympathectomy
Other Name: Botox


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Be admitted to the ICU
  • Have digital ischemia and
  • Be on a vasopressor infusion

Exclusion Criteria:

  • Patients with a history of systemic sclerosis
  • Patients actively receiving aminoglycoside antibiotics - aminoglycosides may potentiate the effect of Botox
  • Patients who have previously received botulinum toxin (A or B) injections
  • Patients with a history of disorders of neuromuscular transmission (e.g myasthenia gravis, Lambert-Eaton, etc.) - Botox may have a lasting effect in these patients given their disorder
  • Patients with clinical evidence of an infection in either forearm or hand
  • Patients with a history of sensitivity to albumin - Botox is sold in powder form and there is albumin in the formulation
  • Pregnancy - Botox is a class C medication
  • Rheumatoid Arthritis
  • Upper extremity arterio-venous graft or fistula
  • Digital necrosis
  • History of hand amputation
  • Patients whom the intensive care attending physician deems will expire within 48 hours
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Please refer to this study by its identifier: NCT01483209

United States, North Carolina
Duke University Medical Center
Durham, North Carolina, United States, 27710
Sponsors and Collaborators
Duke University
Principal Investigator: Cynthia Shortell, MD Duke UMC
Study Director: Detlev Erdmann, M.D., Ph. D. Duke UMC
  More Information

Responsible Party: Duke University Identifier: NCT01483209     History of Changes
Other Study ID Numbers: Pro00032002
Study First Received: November 29, 2011
Results First Received: February 16, 2015
Last Updated: February 16, 2015

Keywords provided by Duke University:
Digital ischemia

Additional relevant MeSH terms:
Pathologic Processes
Vasoconstrictor Agents
Botulinum Toxins
Botulinum Toxins, Type A
Acetylcholine Release Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Cholinergic Agents
Neurotransmitter Agents
Physiological Effects of Drugs
Neuromuscular Agents
Peripheral Nervous System Agents processed this record on May 25, 2017