Mean Arterial Pressure After Out-of-hospital Cardiac Arrest

Launched by CENTRE HOSPITALIER LE MANS · Aug 2, 2022

Keywords

ClinConnect Summary

This clinical trial is studying the impact of maintaining different levels of blood pressure, specifically mean arterial pressure (MAP), in patients who have experienced an out-of-hospital cardiac arrest. The main goal is to determine whether keeping the blood pressure higher (at least 90 mmHg) in the first 24 hours after the cardiac arrest can lead to better brain function and overall outcomes compared to the standard target of 65 mmHg. This is important because maintaining proper blood flow to the brain is crucial after such an event, and the researchers want to find the best way to support patients during their recovery.

To be eligible for the study, participants must be adults aged 65 years or older who have been admitted to an intensive care unit (ICU) after an out-of-hospital cardiac arrest. They should have shown signs of circulation for at least 20 minutes after the cardiac arrest and require mechanical ventilation due to a coma. However, certain individuals, such as those under 18 years old, or those with specific medical conditions or circumstances, will not be included in the trial. If someone participates, they will receive either the standard or the higher blood pressure treatment, and the effects on their brain function will be monitored. This trial is actively recruiting participants to help improve care for future patients who experience cardiac arrest.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Admission to ICU following an out-of-hospital cardiac arrest with an initially shockable or non-shockable rhythm ;
• • Sustained ROSC defined as 20 minutes with signs of circulation without the need for chest compressions;
• • Under invasive mechanical ventilation for coma, defined as a Glasgow score ≤ 8/15;
• • Consent from a relative or of a procedure for emergency inclusion.
• Exclusion Criteria:
• • Age \< 18 years ;
• • In-hospital cardiac arrest (first cardiac arrest);
• • Unwitnessed CA with initial rhythm of asystole
• • Delay between ROSC and attempting randomisation \> 6 hours ;
• • Cardiac arrest in a context of multiple trauma ;
• • Cardiac arrest in a context of hemorrhagic shock or severe hemorrhage necessitating hemostasis (surgery or radiological or endoscopic hemostasis) ;
• • Cardiac arrest secondary to an acute brain disease (ischemic or hemorrhagic stroke, subarachnoid hemorrhage, severe traumatic brain injury) ;
• * Refractory shock :
• • Defined as a MAP \< 65 mmHg for more than one hour on norepinephrine or epinephrine at a dose \> 1 µg/kg/min despite adequate fluid resuscitation ;
• • Extracorporeal circulatory support prior to inclusion;
• • Known allergy to norepinephrine or to any of its excipients;
• • Decision to limit care before inclusion ;
• • Modified Rankin score of 4 or 5 before cardiac arrest ;
• • Inclusion in another interventional study in which the principal endpoint is neurological prognosis ;
• • Pregnancy or breast feeding ;
• • Adult patient deprived of freedom or under legal protection (patients under guardianship or curatorship) (article L1121-6 of the French Health Code) ;
• • Non-French speaking;
• • Patient already included in this trial ;
• • Absence of social security cover.