Heart Arrest, Hypothermia
Conditions
Keywords
Heart arrest, Cardiopulmonary resuscitation, Humans, Hypothermia, Brain diseases, Hypoxia-ischemia, Cost Benefit Analysis, Prospective study, Comparative study, Treatment outcome, Hypothermia for, out-of-hospital cardiac arrest, from cardiac origin, successfully resuscitated
Brief summary
According to international guidelines, mild therapeutic hypothermia is recommended for resuscitated patients after cardiac arrest due to ventricular fibrillation. Whether external or internal cooling is superior in terms of prognosis or security remains unknown. The aim of this study is to evaluate in a randomized trial the clinical and economical interests of the endovascular cooling versus the conventional external cooling for the management of hypothermia after cardiac arrest.
Detailed description
According to international guidelines, mild therapeutic hypothermia is recommended for resuscitated patients after experiencing cardiac arrest from cardiac origin: unconscious adult patients with spontaneous circulation after cardiac arrest should be cooled to 32-34°C for 12-24 hours when the initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia. Such cooling may also be beneficial for other rhythm or in-hospital cardiac arrest. External or internal cooling techniques can be used to initiate cooling within minutes to hours. The two main randomized and positive studies dealing with the efficiency of hypothermia after cardiac arrest have used external cooling systems. However, several animal studies documented the importance of initiating hypothermia as soon as possible after cardiac arrest. Intravascular cooling enables more rapid induction of hypothermia compared with external cooling method after brain injury. Although several human studies have also documented that intravascular cooling provides more precise control of core temperature than external methods and although an endovascular method has been used safely in pilot studies in those experiencing hypothermia after cardiac arrest, the superiority of such a cooling on the prognosis after cardiac arrest remains unknown, as well as its cost efficiency. The aim of this study is to evaluate in a randomized trial the potential clinical and economical interests of the endovascular cooling versus the conventional external cooling for the management of cardiac arrest from cardiac origin. With a clinical primary endpoint (survival without major neurological sequels), this study will also focus on important secondary endpoints, as the burden of nurse work and the economical costs induced by these 2 different methods of cooling.
Interventions
PROCEDUREComparison of 2 cooling procedures
Comparison of 2 cooling procedures
Sponsors
Alsius Corporation
distributed in France by
IST Cardiology (Le Fresne Camilly, France)
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 79 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 79 years old * Out-of-hospital cardiac arrest (OH-CA) due to a presumed cardiac etiology * Delay between OH-CA and return of spontaneous circulation (ROSC) \< 60 minutes * Delay between ROSC and starting cooling \< 240 minutes * Patient not obeying verbal command after ROSC and prior to starting cooling * Availability of the CoolGard device (ALSIUS product)
Exclusion criteria
* Do not reanimate order or terminal disease before inclusion * Known pregnancy * Clinical hemorrhagic syndrome or known coagulopathy * Contra-indication to device usage (such as femoral venous access impossible) * Hypothermia at admission \< 30°C * Etiology of OH-CA thought to be extra-cardiac (trauma, bleeding or anoxia) * In hospital cardiac arrest * Refractory shock (need for extra-corporeal life support)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Clinical interest of endovascular cooling versus conventional external cooling for the management of cardiac arrest from cardiac origin | 28 days |
Secondary
| Measure | Time frame |
|---|---|
| Evaluation of the paramedical burden of work | at 28 days |
| Evaluation of the nurse's satisfaction index | at 28 days |
| Evaluation of treatment costs: global costs and costs within the first 48 hours of hospitalization | at 28 days |
| Time necessary to reach the target temperature (33°C): mean speed of temperature decrease | at 28 days |
| deviations of more than 1°C compared with the target temperature during the 24 hours (24H) after reaching that target temperature | at 28 days |
| mean speed of rewarming | at 28 days |
| Cost/efficiency ratio (endovascular versus conventional cooling) | at 28 days |
| Analysis according to the type and the cause of the cardiac arrest, duration of resuscitation maneuvers, success of coronary angioplasty, number of organ failures (Logistic Organ Dysfunction System [LODS] | at 28 days |
| Sequential Organ Failure Assessment [SOFA] | at 28 days |
| and Organ Dysfunctions and/or Infection [ODIN] scores | at 28 days |
| Simplified Acute Physiology [SAPS II]), duration of Intensive Care Unit (ICU) stay and duration of mechanical ventilation | at 28 days |
| The efficiency is measured on survival and on better neurological outcome, as defined by CPC 1 or 2 on the Pittsburgh cerebral performance categories (CPC), with an expected 12% improvement of the survival without major sequels at day 28 after inclusion. | at 28 days and 90 days |
| Safety of the method (type of adverse events) | at 28 days |
Countries
France
Outcome results
None listed