Carbon Dioxide, Oxygen and Mean Arterial Pressure After Cardiac Arrest and Resuscitation

Conditions

Out-of-Hospital Cardiac Arrest

Keywords

Out-of-Hospital Cardiac Arrest, Resuscitation, Hypoxia-Ischemia, Brain

Brief summary

The COMACARE trial is a pilot multicenter randomized trial to assess the feasibility and effect on brain injury markers of targeting low or high normal arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2) and mean arterial pressure (MAP) in comatose, mechanically ventilated patients after out-of-hospital cardiac arrest. Using factorial design, participants are randomized at admission to intensive care unit to one of eight groups targeting either low or high normal values of PaO2, PaCO2 and MAP for 36 h. In this way, investigators will be assessing the feasibility and effect of all three variables at the same time. The primary outcome is serum concentration of neuron-specific enolase (NSE) at 48 h after cardiac arrest. Feasibility outcome is between-group separation in PaO2, PaCO2 and MAP levels. Secondary outcomes include continuous monitoring of cerebral oxygenation, EEG and ECG for 48 h, the levels of NSE, S100B and cardiac troponin at randomization and 24, 48 and 72 h after cardiac arrest and neurological assessment at 6 months after cardiac arrest.

Kortesuo E, Tirkkonen J, Reinikainen M, Pekkarinen PT, Moilanen E, Petäjä L, Skrifvars MB, Hästbacka J.

2025-12-05

10.1016/j.resplu.2025.101187

The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials.

Laurikkala J, Ameloot K, Reinikainen M, Palmers PJ, De Deyne C, Bert F, Dupont M, Janssens S, Dens J, Hästbacka J, Jakkula P, Loisa P, Birkelund T, Wilkman E, Vaara ST, Skrifvars MB.

2023-11-211 citations

10.1186/s13613-023-01210-0

Abstract 126: The Association Of Higher Or Lower Mean Arterial Pressure On Kidney Function After Cardiac Arrest: A Post-hoc Analysis Of The Comacare And Neuroprotect Trials

Johanna Laurikkala, Koen Ameloot, Matti Reinikainen, Pieter‐Jan Palmers, Eline Bogaerts et al. (17 authors)

Circulation2022-11-08

10.1161/circ.146.suppl_1.126

GFAp and tau protein as predictors of neurological outcome after out-of-hospital cardiac arrest: A post hoc analysis of the COMACARE trial.

Humaloja J, Lähde M, Ashton NJ, Reinikainen M, Hästbacka J, Jakkula P, Friberg H, Cronberg T, Pettilä V, Blennow K, Zetterberg H, Skrifvars MB, COMACARE Study Groups.

2021-12-0121 citations

10.1016/j.resuscitation.2021.11.033

Association of deranged cerebrovascular reactivity with brain injury following cardiac arrest: a post-hoc analysis of the COMACARE trial

Johanna Laurikkala, Anders Åneman, Alexander Peng, Matti Reinikainen, Paul Pham et al. (14 authors)

Critical Care2021-09-2833 citations

10.1186/s13054-021-03764-6

High Oxygen Does Not Increase Reperfusion Injury Assessed with Lipid Peroxidation Biomarkers after Cardiac Arrest: A Post Hoc Analysis of the COMACARE Trial

Jaana Humaloja, Máximo Vento, Julia Kuligowski, Sture Andersson, José David Piñeiro-Ramos et al. (13 authors)

Journal of Clinical Medicine2021-09-175 citations

10.3390/jcm10184226

Serum fibroblast growth factor 21 levels after out of hospital cardiac arrest are associated with neurological outcome

Pirkka T. Pekkarinen, Markus B. Skrifvars, Ville Lievonen, Pekka Jakkula, Laura Albrecht et al. (10 authors)

Scientific Reports2021-01-1210 citations

10.1038/s41598-020-80086-7

Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest.

Ameloot K, Jakkula P, Hästbacka J, Reinikainen M, Pettilä V, Loisa P, Tiainen M, Bendel S, Birkelund T, Belmans A, Palmers PJ, Bogaerts E, Lemmens R, De Deyne C, Ferdinande B, Dupont M, Janssens S, Dens J, Skrifvars MB.

2020-08-0170 citations

10.1016/j.jacc.2020.06.043

Abstract 31: Low versus High Blood Pressure Targets After Out-Of-Hospital Cardiac Arrest

Pekka Jakkula, Koen Ameloot, C. De Deyne, Jo Dens, Matti Reinikainen et al. (8 authors)

Circulation2019-11-19

10.1161/circ.140.suppl_2.31

Near-infrared spectroscopy after out-of-hospital cardiac arrest.

Jakkula P, Hästbacka J, Reinikainen M, Pettilä V, Loisa P, Tiainen M, Wilkman E, Bendel S, Birkelund T, Pulkkinen A, Bäcklund M, Heino S, Karlsson S, Kopponen H, Skrifvars MB.

2019-05-1429 citations

10.1186/s13054-019-2428-3

Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial.

Jakkula P, Reinikainen M, Hästbacka J, Loisa P, Tiainen M, Pettilä V, Toppila J, Lähde M, Bäcklund M, Okkonen M, Bendel S, Birkelund T, Pulkkinen A, Heinonen J, Tikka T, Skrifvars MB, COMACARE study group.

2018-11-14135 citations

10.1007/s00134-018-5453-9

Targeting low- or high-normal Carbon dioxide, Oxygen, and Mean arterial pressure After Cardiac Arrest and REsuscitation: study protocol for a randomized pilot trial.

Jakkula P, Reinikainen M, Hästbacka J, Pettilä V, Loisa P, Karlsson S, Laru-Sompa R, Bendel S, Oksanen T, Birkelund T, Tiainen M, Toppila J, Hakkarainen A, Skrifvars MB, COMACARE study group.

2017-10-3025 citations

10.1186/s13063-017-2257-0

Interventions

OTHERLow normal PaCO2

4.5-4.7 kPa

OTHERHigh normal PaCO2

5.8-6.0 kPa

OTHERLow normal PaO2

10-15 kPa

OTHERHigh normal PaO2

20-25 kPa

OTHERLow normal MAP

65-75 mmHg

OTHERHigh normal MAP

80-100 mmHg

Study design

Allocation

RANDOMIZED

Intervention model

FACTORIAL

Primary purpose

TREATMENT

Masking

SINGLE (Outcomes Assessor)

Masking description

The physician determining neurological outcome at six months after cardiac arrest is blinded to the study group allocations

Eligibility

Sex/Gender

ALL

Age

18 Years to 80 Years

Healthy volunteers

No

Inclusion criteria

* Witnessed out-of-hospital cardiac arrest with ventricular fibrillation (VF) or ventricular tachycardia (VT) as the initial rhythm * Delay of return of spontaneous circulation (ROSC) 10-45 min from the start of the arrest * Confirmed or suspected cardiac origin * Mechanical ventilation * Markedly impaired level of consciousness (no response to verbal commands and Glasgow coma scale \[GCS\] motor score \< 5) * Deferred consent possible or likely * Active intensive care initiated, including targeted temperature management (33-36 C)

Exclusion criteria

* Probable withdrawal of active ICU care due to terminal illness or poor prognosis because of severely reduced functional status before cardiac arrest * Confirmed or suspected intracranial pathology and/or suspicion of raised intracranial pressure * Pregnancy * Severe oxygenation problem (PaO2 / FiO2 \< 100 mmHg) * Severe COPD

Design outcomes

Primary

Measure	Time frame
Neuron-specific enolase (NSE) serum concentration	48 hour after cardiac arrest

Secondary

Measure	Time frame
Cardiac troponin (TnT) serum concentration	At randomization and 24, 48 and 72 hour after cardiac arrest
Cerebral oxygenation monitoring using near infrared spectroscopy (NIRS) monitoring	For 48 hour after admission to ICU
Continuous electroencephalography (EEG) monitoring	For 48 hour after admission to ICU
Functional status using cerebral performance category (CPC) classification	At 30 days and 6 months after cardiac arrest
Neuron-specific enolase (NSE) serum concentration	At randomization and 24 and 72 hour after cardiac arrest
S100B protein serum concentration	At randomization and 24, 48 and 72 hour after cardiac arrest

Other

Measure	Time frame
Between-group separation in MAP	Every 1 hour for 36 hour after admission to ICU
Between-group separation in PaCO2	Every 3 hour for 36 hour after admission to ICU
Between-group separation in PaO2	Every 3 hour for 36 hour after admission to ICU

Countries

Denmark, Finland

Outcome results

None listed