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Out-Of-Hospital Cardiac ArrestNCT04058925

Tissue Oxygenation During Cardiopulmonary Resuscitation as a Predictor of Return of Spontaneous Circulation

An observational study of Out-Of-Hospital Cardiac Arrest, run by Miha Košir at 1 site in Slovenia.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The main objective of the trial is to find out if there is correlation between cerebral and skeletal muscle oxygenation values during cardiopulmonary resuscitation and if these values can predict return of spontaneous circulation. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Out-Of-Hospital Cardiac Arrest
What is being tested?
NIRS device
Type of treatment
Medical device
How many people
30 participants
Where
1 siteSlovenia
Study dates
1 Sep 2019to 1 Apr 2022
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: The adult population of city Ljubljana and surrounding municipality is which the emergency first aid is provided by Basic emergency first aid infirmary of Community Health Centre Ljubljana. The area is 1670 km2 big and there are up to 450.000 people.

Who may be able to join

  • non-traumatic cardiac arrest in prehospital environment
  • age 18 years or more

Who cannot join

  • age 18 years or less
  • pregnancy
  • traumatic cause of cardiac arrest
  • hypothermia
  • drowning
  • E-CPR protocol (candidates for ECMO CPR)
  • spontaneous circulation upon arrival of emergency team at the scene

Trial locations and contacts

1 site in 1 country.

Slovenia1 site
  • University Medical Centre Ljubljana

    Ljubljana, 1000

Other trials in Slovenia

About this study

Official title: Cerebral and Skeletal Muscle Oxygenation During Cardiopulmonary Resuscitation as a Predictor of Return of Spontaneous Circulation

The main objective of the trial is to find out if there is correlation between cerebral and skeletal muscle oxygenation values during cardiopulmonary resuscitation and if these values can predict return of spontaneous circulation. The investigators would like to find out which values, first measures, average, maximal, are better predictor of return of spontaneous circulation. All the patients with nontraumatic cardiac arrest in prehospital environment will be enrolled in the study. The measurements will be taken with NIRS device and special electrodes, which will be placed on patient's forehead and thenar eminence od right hand. No ALS procedure will be modified.

Read the detailed description

Out of hospital cardiac arrest (OHCA) is major cause of morbidity and mortality around the world. Annually there is around 350.000 deaths in the Europe because of OHCA. Despite a great progress in prehospital and emergency medicine in recent years, there is no major increase in surviving OHCA. There are many factors which influence to the end result of OHCA. Till now we still don't know how to predict the outcome of cardiac arrest in early phase of cardiopulmonary resuscitation (CPR).

Today emergency teams use end-tidal CO2 values (etCO2) as an indirect marker of cardiac output and as an auxiliary indicator of return of spontaneous circulation (ROSC). Higher values are also correlated with greater probability of ROSC.

Studies in recent years showed that there could be another method which could help to predict the result of OHCA. Near-infrared spectroscopy (NIRS) is a noninvasive spectroscopic method, which uses light near to infrared electromagnetic spectrum of light. The device can, based on Beer-Lambert law, calculates tissue oxygenation of underlaid tissue. It is also useful in the states, where there is little or even no blood flow (cardiac arrest). NIRS is currently used in operating rooms and ICU, but there is also option to use it in prehospital environment. During cardiac arrest the blood flow through organs is very low or absent. This causes hypoxic-ischemic brain injury and also injury of other vital organs. Based on previous studies with NIRS, we can measure cerebral oxygenation by placing electrodes on patient's forehead. Patients with higher values had greater probability of ROSC. It is presumed, that NIRS values are indirect indicator of coronary perfusion pressure. It is known that higher coronary perfusion pressure is connected with higher oxygen concentration in the brain during cardiac arrest. NIRS can also predict re-arrest even before losing a pulse.

Till today there are no studies which would look for correlation between cerebral and skeletal oxygenation during cardiac arrest.

The investigator's study is monocentric, prospective, observational, nonrandomized taking place at Emergency department of University Medical Centre Ljubljana (UMC Ljubljana). There is also a Basic emergency first aid infirmary (Unit SNMP) of Community Health Centre Ljubljana, which will with it's prehospital units make the measurements. After an eyewitness of cardiac arrest will call on emergency number 112 a medical dispatcher will activate medical team with emergency doctor and send them to the location. Upon arrival the team will start CPR based on ALS protocol. As soon as possible one of team members will put two NIRS electrodes on the patient - one on the patient's forehead and the other on patient's thenar eminence on the hand. ALS protocol will not be modified in any way. The NIRS device (Nonin SenSmart Model X-100) will be turned on till the end of resuscitation or till arrival to the hospital (UMC Ljubljana).

Being tested
NIRS device
Keywords
Out-Of-Hospital Cardiac Arrest, Near-infrared spectroscopy
Medical subject headings
Out-of-Hospital Cardiac Arrest

What participants receive

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

  • NIRS deviceDevice

    Application of NIRS electrode to forehead and thenar eminence.

What is being measured

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

  1. Correlation between cerebral oxygenation and skeletal oxygenation values.

    coefficient

    Measured: 30 minutes

  2. First measures cerebral oxygenation and skeletal oxygenation values as a predictor of ROSC.

    percent

    Measured: 1 minute

  3. Average values of cerebral oxygenation and skeletal oxygenation values as a predictor of ROSC.

    percent

    Measured: 30 minutes

  4. Absolute change of cerebral oxygenation and skeletal oxygenation values in ROSC and NON-ROSC patients.

    percent

    Measured: 30 minutes

Timeline

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

  1. First posted16 Aug 2019
  2. Study start1 Sep 2019
  3. Primary completion1 Apr 2022
  4. Study completion1 Apr 2022

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
Case only
Time perspective
Prospective
Enrolment
30 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04058925
Sponsor's protocol ID
UMC-NIRS/CPR
Status last verified
May 2022
First submitted
14 Aug 2019
Last updated
6 May 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Grasner JT, Bottiger BW, Bossaert L; European Registry of Cardiac Arrest (EuReCa) ONE Steering Committee; EuReCa ONE Study Management Team. EuReCa ONE - ONE month - ONE Europe - ONE goal. Resuscitation. 2014 Oct;85(10):1307-8. doi: 10.1016/j.resuscitation.2014.08.001. Epub 2014 Aug 15. No abstract available.

    PubMed 25132474
  • Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):63-81. doi: 10.1161/CIRCOUTCOMES.109.889576. Epub 2009 Nov 10.

    PubMed 20123673
  • Sandroni C, Cariou A, Cavallaro F, Cronberg T, Friberg H, Hoedemaekers C, Horn J, Nolan JP, Rossetti AO, Soar J. Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Resuscitation. 2014 Dec;85(12):1779-89. doi: 10.1016/j.resuscitation.2014.08.011.

    PubMed 25438253
  • Genbrugge C, Meex I, Boer W, Jans F, Heylen R, Ferdinande B, Dens J, De Deyne C. Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with return of spontaneous circulation. Crit Care. 2015 Mar 24;19(1):112. doi: 10.1186/s13054-015-0837-5.

    PubMed 25887259
  • Frisch A, Suffoletto BP, Frank R, Martin-Gill C, Menegazzi JJ. Potential utility of near-infrared spectroscopy in out-of-hospital cardiac arrest: an illustrative case series. Prehosp Emerg Care. 2012 Oct-Dec;16(4):564-70. doi: 10.3109/10903127.2012.702191. Epub 2012 Jul 23.

    PubMed 22823984
  • Cournoyer A, Iseppon M, Chauny JM, Denault A, Cossette S, Notebaert E. Near-infrared Spectroscopy Monitoring During Cardiac Arrest: A Systematic Review and Meta-analysis. Acad Emerg Med. 2016 Aug;23(8):851-62. doi: 10.1111/acem.12980.

    PubMed 27028004
  • Prosen G, Strnad M, Doniger SJ, Markota A, Stozer A, Borovnik-Lesjak V, Mekis D. Cerebral tissue oximetry levels during prehospital management of cardiac arrest - A prospective observational study. Resuscitation. 2018 Aug;129:141-145. doi: 10.1016/j.resuscitation.2018.05.014. Epub 2018 May 12.

    PubMed 29763712
  • Jones S, Chiesa ST, Chaturvedi N, Hughes AD. Recent developments in near-infrared spectroscopy (NIRS) for the assessment of local skeletal muscle microvascular function and capacity to utilise oxygen. Artery Res. 2016 Dec;16:25-33. doi: 10.1016/j.artres.2016.09.001.

    PubMed 27942271
  • Mozina H, Podbregar M. Near-infrared spectroscopy during stagnant ischemia estimates central venous oxygen saturation and mixed venous oxygen saturation discrepancy in patients with severe left heart failure and additional sepsis/septic shock. Crit Care. 2010;14(2):R42. doi: 10.1186/cc8929. Epub 2010 Mar 23.

    PubMed 20331856
  • Schnaubelt S, Sulzgruber P, Menger J, Skhirtladze-Dworschak K, Sterz F, Dworschak M. Regional cerebral oxygen saturation during cardiopulmonary resuscitation as a predictor of return of spontaneous circulation and favourable neurological outcome - A review of the current literature. Resuscitation. 2018 Apr;125:39-47. doi: 10.1016/j.resuscitation.2018.01.028. Epub 2018 Feb 2.

    PubMed 29410191
  • Wik L. Near-infrared spectroscopy during cardiopulmonary resuscitation and after restoration of spontaneous circulation: a valid technology? Curr Opin Crit Care. 2016 Jun;22(3):191-8. doi: 10.1097/MCC.0000000000000301.

    PubMed 27054625
  • Singer AJ, Ahn A, Inigo-Santiago LA, Thode HC Jr, Henry MC, Parnia S. Cerebral oximetry levels during CPR are associated with return of spontaneous circulation following cardiac arrest: an observational study. Emerg Med J. 2015 May;32(5):353-6. doi: 10.1136/emermed-2013-203467. Epub 2014 Mar 24.

    PubMed 24662518
  • Kalkan A, Bilir O, Ersunan G, Ozel D, Tas M, Memetoglu ME. Abdominal oxygen saturation for monitoring return of spontaneous circulation in out-of-hospital cardiac arrest using near infrared spectrophometry. Am J Emerg Med. 2015 Mar;33(3):344-8. doi: 10.1016/j.ajem.2014.11.029. Epub 2014 Nov 28.

    PubMed 25559313
  • Mozina H, Podbegar M. Near-infrared spectroscopy for evaluation of global and skeletal muscle tissue oxygenation. World J Cardiol. 2011 Dec 26;3(12):377-82. doi: 10.4330/wjc.v3.i12.377.

    PubMed 22216373
  • Friess SH, Sutton RM, French B, Bhalala U, Maltese MR, Naim MY, Bratinov G, Arciniegas Rodriguez S, Weiland TR, Garuccio M, Nadkarni VM, Becker LB, Berg RA. Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation. Resuscitation. 2014 Sep;85(9):1298-303. doi: 10.1016/j.resuscitation.2014.05.040. Epub 2014 Jun 16.

    PubMed 24945902

Questions about this trial

What is this clinical trial studying?

An observational study of Out-Of-Hospital Cardiac Arrest, run by Miha Košir at 1 site in Slovenia.

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 2 inclusion and 7 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: finished, as of the sponsor's last update on 6 May 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Slovenia. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Correlation between cerebral oxygenation and skeletal oxygenation values. (time frame: 30 minutes). The study lists 4 primary outcomes in all. 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 NCT04058925, which also lists 18 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 6 May 2022.

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