IMPACT (International Multi-center Protocol to quantify the relative impact of single and combined Antiemetics in a randomized Controlled Trial of factorial design) has been published in the New England Journal of Medicine 2004
Question
PONV persists as a problem because of the limited effectiveness of a single antiemetic approach. Many studies have investigated combinations but it has never been systematically investigated which antiemetic combination is best. This study shall answer the question which combination out of six well established antiemetic approaches is best.
Design and Methods
IMPACT is the first study in the field of medicine with an adequate size and design which allows to investigate whether, and if so, how two or three out of six drugs work together (interact).
The IMPACT data could only be collected with the enormous effort and ambition of all IMPACT investigators who are the true owner of this impressive dataset and have the right of direct access to the data.
As it has now been shown for the first time that all three antiemetics are equally effective (previous meta-analyses had conflicting results) it makes sense to use the safest and cheapest drug first. In the absence of evidence for side-effects from a single dose of 4 mg dexamethasone i.v. this would be our first choice.
