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Postcardiac ArrestNCT02033720

Study of Survivors of Different Types of Cardiac Arrest and Their Neurological Recovery

An observational study of Postcardiac Arrest and Pulseless Electrical Activity, run by London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's at 2 sites in Canada.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

After successful resuscitation from certain types of cardiac arrest, total body cooling is now a well established treatment that improves the chances of the brain recovering. This however, has only been definitively proven after a certain type of cardiac arrest that is "ventricular fibrillation / ventricular… Read more about this study

Who is it for?
Ages 18 to 90 years
What is being tested?
No treatment and Therapeutic hypothermia
How many people
400 participants
Where
2 sitesCanada
Study dates
Jan 2014to Feb 2015
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: All patients admitted to the intensive care unit (ICU) with a diagnosis of postcardiac arrest between Jan 2008 and Dec 2012 will be examined.

Who may be able to join

  • Admission to adult ICU (age ≥18 years) at London Health Sciences Centre
  • Primary reason for ICU admission: postcardiac arrest
  • Both in-hospital and out-of-hospital cardiac arrest will be included
  • ICU admission between Jan 2008 and Dec 2012.

Who cannot join

  • ICU admissions primarily for reasons other than cardiac arrest.

Trial locations and contacts

2 sites in 1 country.

Ahmed F Hegazy, MD, FRCPC contact

1(519) 860-4917

ahmed.hegazy@londonhospitals.ca

Eyad AlThenayan, MD contact

Eyad.Althenayan@lhsc.on.ca

Canada2 sites
  • University Hospital, London Health Sciences Centre, University of Western Ontario

    London, Ontario, N6A 5A5

    Ahmed F Hegazy, MD, FRCPC, 1(519) 860-4917, ahmed.hegazy@londonhospitals.ca

    Eyad Althenayan, MD, 1 (519) 685-8500 ext. 19119, eyad.althenayan@lhsc.on.ca

  • Victoria Hospital, London Health Sciences Centre, University of Western Ontario

    London, Ontario, N6A 5W9

    Ahmed F Hegazy, MD, FRCPC, 1(519) 860-4917, ahmed.hegazy@londonhospitals.ca

    Eyad Althenayan, MD, 1 (519) 685-8500 ext. 19119, eyad.althenayan@lhsc.on.ca

Other trials in Canada

About this study

Official title: Neurological Outcomes After Cardiac Arrest in Pulseless Electrical Activity in Comparison to Asystole. Are All Non-shockable Rhythms the Same?

After successful resuscitation from certain types of cardiac arrest, total body cooling is now a well established treatment that improves the chances of the brain recovering. This however, has only been definitively proven after a certain type of cardiac arrest that is "ventricular fibrillation / ventricular tachycardia". The purpose of this study is to explore if total body cooling is beneficial for patients recovering from another type of cardiac arrest that is "pulseless electrical activity".

HYPOTHESIS:

Patients undergoing post-cardiac arrest therapeutic hypothermia have better neurological outcomes if their initial arrest rhythm is pulseless electrical activity (PEA) in comparison to asystole.

Read the detailed description

STUDY RATIONALE AND BACKGROUND INFORMATION:

After successful resuscitation from cardiac arrest the body experiences a period of global reperfusion. During this period, patients may show signs of myocardial stunning, lactic acidosis, neurological injury and reperfusion syndrome. This constellation of findings constitutes what is known as post-cardiac arrest syndrome. The brain appears to be one of the most vulnerable organs to injury during this reperfusion phase and varying degrees of cognitive impairment may be the end result. Inducing mild therapeutic hypothermia has been shown to be protective for the brain in this setting and has been demonstrated to improve neurological recovery. The evidence for this however, is only conclusive in cases where the arrest is in a shockable rhythm i.e. pulseless ventricular tachycardia and ventricular fibrillation.

In 2002, two randomized controlled trials were published showing an improvement in neurological outcomes in patients treated with mild therapeutic hypothermia post resuscitation from shockable cardiac arrest. Therapeutic hypothermia has since been widely adopted by most authorities as part of the comprehensive treatment bundle for post cardiac arrest syndrome. Whether there is any benefit for patients arrested in non-shockable rhythms however, is a matter of controversy. Some have reported improved mortality and better neurological outcomes with therapeutic hypothermia in this patient population. Others have reported no benefit or even a trend towards harm. And although the matter remains controversial, the recommendation still stands for therapeutic hypothermia to be offered for all comatose survivors of cardiac arrest whatever the arrest rhythm.

Most previous reports have examined the differences between shockable and non-shockable rhythms in terms of neurological outcome and mortality rates after therapeutic hypothermia. To our knowledge, no study has examined the differences in outcome between the two types of non-shockable rhythms, that is pulseless electrical activity (PEA) and asystole. We hypothesize that during PEA arrests, patients may retain some degree of cerebral perfusion and hence have better neurological outcomes post-resuscitation. That is in contrast to asystole where patients are likely to have no cerebral perfusion. In this study we attempt to detect any possible differences in neurological recovery (as indicated by the Cerebral Performance Category scale on hospital discharge) after therapeutic hypothermia, between patients arrested in PEA arrest and those arrested in asystole.

Being tested
No treatment, Therapeutic hypothermia
Keywords
postcardiac arrest, post cardiac arrest syndrome, post cardiac arrest hypothermia, pulseless electrical activity, asystole, therapeutic hypothermia, therapeutic hypothermia after cardiac arrest, therapeutic hypothermia neurologic outcome
Medical subject headings
Heart Arrest, Post-Cardiac Arrest Syndrome

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • No treatmentOther

    Also called No therapeutic hypothermia., Control.

    No therapeutic hypothermia was induced.

  • Therapeutic hypothermiaOther

    Also called Hypothermia, Induced hypothermia, Mild therapeutic hypothermia, Cooling

    Hypothermia was induced after successful resuscitation from cardiac arrest.

Study groups in NCT02033720
Study groupRoleWhat they receive
Shockable arrestInitial arrest rhythm shockable. This is either pulseless ventricular tachycardia (pulseless VT) or ventricular fibrillation (VF).
Receives: Other: No treatment; Other: Therapeutic hypothermia
Pulseless electrical activityInitial arrest rhythm is pulseless electrical activity.
Receives: Other: No treatment; Other: Therapeutic hypothermia
AsystoleInitial arrest rhythm is asystole.
Receives: Other: No treatment; Other: Therapeutic hypothermia

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Cerebral performance category score on hospital discharge

    Neurological outcome on discharge from hospital as defined by the cerebral performance category (CPC) scale. The CPC scale is a 5 point scale. The outcome measure will be dichotomized into good or bad. Good outcome will be equivalent to CPC scores of 1 \& 2 (where the patient is independent), and bad outcome will be equivalent to CPC scores of 3, 4 \& 5 (where the patient is either dependent or dead).

    CPC Scale:

    1. Functioning normally and independent, possibly with a minor disability.
    2. Moderately disabled, still independent.
    3. Conscious but with a severe disability, dependent.
    4. Unconscious (comatose or in a persistent vegetative state).
    5. Brain dead or dead by traditional criteria.

    Measured: Upon discharge from hospital, assessed up to 36 months postcardiac arrest

Secondary outcomes (3)
  1. Hospital length of stay postcardiac arrest

    Hospital length of stay (LOS) post-cardiac arrest will be calculated from the day of the cardiac arrest to the day of hospital discharge. If prior to the arrest the patient was an inpatient, we will only count the days from the arrest to discharge. Days spent in hospital prior to the arrest will not be included.

    Measured: Days spent in hospital after successful resuscitation from cardiac arrest, assessed up to 36 months from the date of cardiac arrest

  2. Intensive care unit length of stay postcardiac arrest

    The length of stay (LOS) in the intensive care unit (ICU) in days, after successful resuscitation from cardiac arrest.

    Measured: Days spent in the intensive care unit after successful resuscitation from cardiac arrest, assessed up to 36 months from the date of cardiac arrest

  3. Neurological status after hospital discharge

    Neurological status as documented on the patient's first outpatient clinic visit, assessed up to 12 months from hospital discharge. This will be analyzed as a secondary outcome only if enough data is generated on chart review.

    Measured: Assessed up to 12 months from hospital discharge

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Jan 2014 (estimated)
  2. Study startJan 2014
  3. Primary completionDec 2014 (estimated)
  4. Study completionFeb 2015 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
400 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02033720
Sponsor's protocol ID
104666
Status last verified
Jan 2014
First submitted
4 Jan 2014
Last updated
13 Jan 2014
Results posted
No
Data monitoring committee
No

Publications

  • Holzer M. Targeted temperature management for comatose survivors of cardiac arrest. N Engl J Med. 2010 Sep 23;363(13):1256-64. doi: 10.1056/NEJMct1002402. No abstract available.

    PubMed 20860507
  • Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002 Feb 21;346(8):557-63. doi: 10.1056/NEJMoa003289.

    PubMed 11856794
  • Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002 Feb 21;346(8):549-56. doi: 10.1056/NEJMoa012689.

    PubMed 11856793
  • Hazinski MF, Nolan JP, Billi JE, Bottiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O'Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, Zideman D. Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010 Oct 19;122(16 Suppl 2):S250-75. doi: 10.1161/CIRCULATIONAHA.110.970897. No abstract available.

    PubMed 20956249
  • Arrich J; European Resuscitation Council Hypothermia After Cardiac Arrest Registry Study Group. Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med. 2007 Apr;35(4):1041-7. doi: 10.1097/01.CCM.0000259383.48324.35.

    PubMed 17334257
  • Testori C, Sterz F, Behringer W, Haugk M, Uray T, Zeiner A, Janata A, Arrich J, Holzer M, Losert H. Mild therapeutic hypothermia is associated with favourable outcome in patients after cardiac arrest with non-shockable rhythms. Resuscitation. 2011 Sep;82(9):1162-7. doi: 10.1016/j.resuscitation.2011.05.022. Epub 2011 Jun 12.

    PubMed 21705132
  • Dumas F, Grimaldi D, Zuber B, Fichet J, Charpentier J, Pene F, Vivien B, Varenne O, Carli P, Jouven X, Empana JP, Cariou A. Is hypothermia after cardiac arrest effective in both shockable and nonshockable patients?: insights from a large registry. Circulation. 2011 Mar 1;123(8):877-86. doi: 10.1161/CIRCULATIONAHA.110.987347. Epub 2011 Feb 14.

    PubMed 21321156

Questions about this trial

What is this clinical trial studying?

An observational study of Postcardiac Arrest and Pulseless Electrical Activity, run by London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's at 2 sites in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 13 Jan 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Ahmed F Hegazy, MD, FRCPC (1(519) 860-4917, ahmed.hegazy@londonhospitals.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Cerebral performance category score on hospital discharge (time frame: Upon discharge from hospital, assessed up to 36 months postcardiac arrest). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02033720, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Jan 2014.

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