Blood Pressure and Cerebral Blood Flow After Cardiac Arrest (NCT05434910) | Clinical Trial Compass
UnknownNot Applicable
Blood Pressure and Cerebral Blood Flow After Cardiac Arrest
Denmark20 participantsStarted 2022-09-09
Plain-language summary
Comatose patients that are admitted to an intensive care unit after out-of-hospital cardiac arrest (OCHA) have a high mortality, particularly due to hypoxic-ischemic neurologic injury. These patients often require vasopressors to maintain mean arterial pressure (MAP), but it is unclear what level of MAP should be aimed for. The objective of the study is to evaluate whether cerebral blood flow (CBF) and cerebral metabolism can be increased by maintaining MAP at a higher level than that used in clinical practice. The study will include twenty comatose patients within two days following resuscitation after OCHA. In the study, MAP is adjusted by infusion of noradrenaline, to a low, moderate, and high level for a short time. The low level of MAP used in the study, corresponds to the level aimed for in clinical practice. The CBF will be evaluated on the neck using ultrasound.
Who can participate
Age range18 Years – 90 Years
SexALL
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Inclusion Criteria:
* Patients who are resuscitated within the last 48 hours after OCHA due to suspected or confirmed cardiac cause.
* Comatose or sedated (Glasgow Coma Score \< 8 whereby the patient is unable to follow verbal commands).
* Age 18-90 years.
Exclusion Criteria:
* Patients that have had in-hospital cardiac arrest.
* Pregnancy, human chorionic gonadotropin is routinely measured in women \< 60 years of age.
* Known hemorrhagic diathesis (medically induced coagulopathy due to blood thinners is not an exclusion criteria, except for those mentioned below).
* Anticoagulant therapy by warfarin with an INR \> 2, Direct-Acting Oral Anticoagulants, or Eptifibatid.
* Suspected or confirmed stroke.
* Non-witnessed cardiac arrest with asystole as the initial rhythm.
* Known treatment limitation plan or a decision not to resuscitate the patient in case of a new cardiac arrest.
* Previous disease that makes 180 day survival unlikely.
* Known Cerebral Performance Category score 3 to 4 prior to cardiac arrest.
* Systolic blood pressure \< 80 mmHg despite optimal fluid-, vasopressor-, and inotropic treatment.
* The need of noradrenaline infusion exceeding 0.3 μg/kg\*min in order to maintain a MAP of 65 mmHg.
* Mechanical cardiac support devices.
* Known vascular disease in the internal carotid artery.
* Lack of visualization of the internal carotid artery, e.g. due to high placement of the bifurcation.
What they're measuring
1
Change in internal carotid artery blood flow.
Timeframe: Evaluations at 2 time points; when MAP is set to 65 and 95 mmHg. The evaluations are separated by approximately 30-60 min.