Is there an alternative to opioids in suspected ACS?


5 Sep 2019

Can you sum up the aim of this project in 10 words?

To determine whether lignocaine is an effective and safe alternative analgesic agent compared to conventional opioid therapy in patients with suspected STEMI.

What have you discovered in this area in the past?

That long held notions of first line management in STEMI can be wrong. We recently showed that oxygen in normoxic patients with ACS is not warranted, and given the increasing data highlighting opioids inhibit gut absorption of antiplatelet agents, it is time to test their efficacy in a randomised controlled trial.

What will your research entail?

We will perform a Phase II, multi-centre, randomised controlled non-inferiority trial of lignocaine versus fentanyl in pre-hospital patients with suspected STEMI. The trial will be coordinated by Ambulance Victoria Research Division and Monash University.

What aspect of this research excites you the most?

For over 50 years every ambulance and ED have been administering opioids to patients with ischaemic chest pain, without significant evidence of benefit. This trial will shed light on if this remains best practice. 

How long before this work might impact patient care?

Whilst acknowledging this is a relatively small phase 2 study, similarly to our trial of oxygen in STEMI, results of the trial have the potential to rapidly change our approach to ischemic chest pain.

What’s your Holy Grail – the one thing you’d like to achieve in your research career?

Continue to question long held ‘truths’ that are not evidence based and perform rigorous clinical trials in critically ill patients who have the most to gain with new treatment modalities.

What is your biggest research hurdle?

Patience! Interventional cardiology often provides instant gratification for example treating a patient with STEMI or severe aortic stenosis. Clinical research is the opposite, very small steps, with years between concept and completion.

Who has inspired you in work or life?

My wife – Dr Romi Stub, an accomplished anaesthetist – who manages work and our hectic life with such grace.

‘There’s an app for that.’ What’s new on your phone?

GoodSAM – a life saving app linked to 000, which alerts you to a nearby cardiac arrest allowing first aid providers to perform CPR until an ambulance arrives. Every heath care worker should have it on their phone.

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