Out-Of-Hospital Cardiac Arrest
Conditions
Keywords
Out-of-hospital cardiac arrest, remote conditioning, ischemic conditioning, ischemia-reperfusion, intensive care unit
Brief summary
Out-of-Hospital Cardiac Arrest remains a major public health problem, resulting in high mortality largely related to multiple organ failure and poor neurological outcomes due to brain anoxia. The pathophysiology of organ dysfunction after resuscitated out-of-hospital cardiac arrest involves ischemia-reperfusion processes. Remote ischemic conditioning is a therapeutic strategy used to protect organs against the detrimental effects of ischemia-reperfusion injury. The objective of the present trial is to determine whether remote ischemic conditioning performed early after out-of-hospital cardiac arrest can decrease mortality, or multiple organ failure and/or severe neurological failure.
Interventions
DEVICERemote ischemic conditioning
A brachial cuff is positioned around one arm of the patient. Remote ischemic conditioning consists of four cycles of a 5-min brachial cuff inflation at 200 mmHg followed by a 5-min of cuff deflation, and is started as soon as possible after randomization. The intervention is repeated 12 and 24 hours after inclusion.
A brachial cuff is positioned around the arm of the patient and no inflation or deflation is performed.
Sponsors
Hospices Civils de Lyon
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 80 years old * Out-of-hospital cardiac arrest, whatever the initial cardiac rhythm (shockable or non-shockable) or the duration of no-flow and low-flow, * Presence of a witness who may or may not have started cardiopulmonary resuscitation, or patient seen alive in the 30 minutes prior to the cardiac arrest, * Hospitalisation in critical care (intensive care unit or cardiac intensive care unit) for less than 3 hours, * Informed consent obtained from a close relative (exceptionally from the patient himself if his condition permits) or, failing this, use of the emergency procedure by the investigator.
Exclusion criteria
* Traumatic cardiac arrest * Patient on extracorporeal circulatory assistance * Cardiac arrest for which continuation of resuscitation does not appear justified (unavoidable death, terminal stage of an irreversible disease, etc.) * Contraindication of the use of brachial cuff on both arms (arteriovenous fistula, lymphoedema or severe peripheral vascular pathology, unstable humeral fracture, continuous infusion into an upper limb vein of an essential drug such as a catecholamine, radial arterial catheter for continuous invasive measurement of blood pressure) * Pregnant, parturient, or breast-feeding women * Patients deprived of their liberty by a judicial or administrative decision, * Patients under legal protection (guardianship, curatorship), * Patient not affiliated to a social security scheme or beneficiary of a similar scheme, * Previous inclusion in the study, * Subject participating in other interventional research that may interfere with the present study according to the investigator's judgement or that includes an exclusion period still in progress at inclusion
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| All cause of death | 72 hours after hospital admission | All-cause death will be assessed 72 hours after hospital admission. |
| Multiple organ failure | 72 hours after hospital admission | Multiple organ failure is defined by a SOFA (Sepsis-related Organ Failure Assessment) score, censored for the neurological component, greater than or equal to 5. |
| Severe neurological failure | 72 hours after hospital admission | Severe neurological failure is defined by a motor component of the Glasgow Coma Score less than or equal to 3, without confounding factors (hypothermia less than or equal to 35.0°C, and/or sedation/analgesia/curarization). The glasgow coma score ranges from 3 to 15 and is broken down into its three parameters: eye opening, verbal response and motor response. The higher the score, the better the patient's recovery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Sepsis-related Organ Failure Assessment (SOFA) score | From hospital admission to 72 hours (or from hospital admission to death if it occurs before 72 hours) | — |
| Mean Sepsis-related Organ Failure Assessment (SOFA) score after exclusion of the neurological sub-score | From hospital admission to 72 hours (or from hospital admission to death if it occurs before 72 hours) | — |
| Variations of the Sepsis-related Organ Failure Assessment (SOFA) score (delta-SOFA) | Between hospital admission to 24 hours, admission to 48 hours and admission to 72 hours | — |
| Sepsis-related Organ Failure Assessment (SOFA) score | 24 hours after hospital admission | The SOFA score ranges from 0 to 24 (higher scores indicate more severe organ failure), with 0 to 4 points assigned for each of 6 organ dysfunctions (ie, central nervous system, cardiovascular, respiratory, renal, coagulation, and liver). |
| Serum level of neuron-specific enolase (NSE) | Between 48 and 72 hours after hospital admission | — |
| Cerebral Performance Categories (CPC) scale | Day 90 | The neurological performance is assessed using the cerebral performance categories (CPC) scale, which ranges from 1 to 5 (with 1 representing good cerebral performance or minor disability, 2 moderate disability, 3 severe disability, 4 coma or vegetative state, and 5 brain death or dead). |
| All-cause mortality | From date of randomization until day 90 after hospital admission | — |
| Variations of the Sepsis-related Organ Failure Assessment (SOFA) score (delta-SOFA) after exclusion of the neurological sub-score | Between hospital admission to 24 hours, admission to 48 hours and admission to 72 hours | — |
| Sepsis-related Organ Failure Assessment (SOFA) score after exclusion of the neurological sub-score | 24 hours after hospital admission | — |
| Sepsis-related Organ Failure Assessment (SOFA) sub-scores for each organ dysfunction | 24 hours after hospital admission | Average SOFA sub-scores for each organ failure scored from 0 to 4 points |
Countries
France
Contacts
Primary ContactMarie-Line Harlay
Backup ContactNaoual EL JONHY
Outcome results
None listed