Cardiac Arrest (CA)
Conditions
Keywords
cardiac arrest, cardiopulmonary resuscitation, CPR, extracorporeal cardiopulmonary resuscitation, ECPR, VA ECMO, colonoscopy, mesenteric ischemia
Brief summary
Bedside colonoscopy 24-36 hours after successful CPR
Detailed description
According to previous observations, many patients after CPR develop acute non-occlusive mesenteric ischemia. However, due to the lack of established screening strategies, the number of unreported cases may be high. Routine colonoscopy at 24-36 hours after CPR may be a safe, easy and cost-effective strategy for early detection of severe mesenteric ischemia and transfer to surgical treatment. However, this strategy has not been formally evaluated in larger prospective cohorts. In our center, we perform routine colonoscopy at 24 to 36 hours after cardiac arrest in all patients who receive extracorporeal CPR (ECPR), i.e., in all patients with prolonged cardiac arrest refractory to conventional CPR measures who therefore receive venoarterial extracorporeal membrane oxygenation (VA ECMO) for cardiocirculatory support. In these patients, colonoscopy screening was feasible and safe, and our data suggest clinical benefit.
Interventions
PROCEDUREcolonoscopy
bedside colonoscopy without bowel cleansing early (24-36h) after successful CPR
Sponsors
University Hospital Freiburg
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Intervention model description
Prospective epidemiological incidence study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* adult patients (≥ 18 years) admitted to the participating department AND * in-hospital or out-of-hospital cardiac arrest (IHCA, OHCA)
Exclusion criteria
* resuscitation period of ≤ 5 minutes * awake and contactable patients (GCS ≥ 13)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Detection of colon ischemia | from baseline (0 hours) until day 30 | Detection of colon ischemia within 30 days after return of spontaneous circulation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| in-hospital mortality | from baseline (0 hours) until hospital discharge | in-hospital mortality |
| abdominal surgery ((hemi-)colectomy) | from baseline (0 hours) until hospital discharge | number of patients requiring/receiving abdominal surgery ((hemi-)colectomy) |
| functional outcome | day 30, day 60 and day 90 | Cerebral Performance Category (CPC) |
| Liver function | within 0-72 hours after CPR | Liver function parameters: Quick/INR, AST, ALT, AP, g-GT |
| renal function | within 0-72 hours after CPR | Renal function parameters: creatinine, BUN |
| Urine output | within 0-72 hours after CPR | Urine output (ml) |
| Renal replacement therapy | from baseline (day 0) until day 30 | Implementation of renal replacement therapy within 30 days after return of spontaneous circulation |
| Serum lactate | within 0-72 hours after CPR | Serum lactate |
| SAPS II score | at 0 hours, 24 hours, 48 hours, 72 hours after CPR | SAPS II |
| SOFA score | at 0 hours, 24 hours, 48 hours, 72 hours after CPR | SOFA |
Countries
Germany
Contacts
CONTACTAlexander Supady, MD, MPH
Outcome results
None listed