Comparison of Cerebral SctO2 Between 36℃ and 33℃ of TTM After Cardiac Arrest
Study Details
Study Description
Brief Summary
The investigators hypothesize that
-
if decrease in SctO2 level is caused by the degree of hypothermia, SctO2 level in the 33-TH may be lower than that in the 36-TH group.
-
if decrease in SctO2 level is not caused by the degree of hypothermia but caused by brain injury, SctO2 level may be associated with only the prognosis of cardiac arrest victims regardless of core temperatures.
The primary objective of this study is to compare the 72-hour changes in SctO2 level between the 36-TH and 33-TH groups in cardiac arrest victims.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Detailed Description
-
Subject Identification and Screening For each cohort, patients will be identified after acquisition of sustained return of spontaneous circulation (ROSC) (> 30 minutes). If the patients meet inclusion/exclusion criteria, patients will be enrolled in the study. The investigators will obtain written informed consent from all of the patients or their representatives.
-
Assignment of Subject Number A unique identification number will be given to study subjects in an attempt to de-identify their information. Subject numbers will be assigned in sequential order. The subject number will consist of four digits. The first two digits will designate the study site. The last two digits will designate the subject by number in sequential order (i.e., subject number 01 01 will be the first subject at site 1; 01 02 will be the second subject at site 1, etc.).
-
Study Methods
-
Randomization to 36-TH (core body temperature (BT) 36℃) or 33-TH (core BT 33℃) group will be performed by a web based randomization site (http://mrcc.snuh.org).
-
Start target temperature management using external cooling device (Arctic Sun) within 1 hour post-ROSC.
-
SctO2 monitoring starts within 1 hour post-ROSC and maintain for 72 hours.
-
36-TH (core BT 36℃) or 33-TH (core BT 33℃) for 24 hours
-
Rewarming 0.25℃/h in 33-TH group
-
Core temperature < 37.5℃ for 72 hours
All patients will be treated per the postresuscitation care protocol. Target treatment will include
-
Target: central venous pressure (CVP) (8 - 12 mmHg), mean arterial pressure (MAP) (> 65 mmHg), central venous oxygen saturation (ScvO2) (> 70%)
-
Seizure control, shivering control as appropriate
-
Coronary intervention as soon as possible if needed
-
Infection control if indicated
-
Other supportive care
Monitoring data including
-
CVP, MAP, ScvO2, lactate, neuron specific enolase (NSE), end-tidal carbon dioxide (EtCO2), input-output (I/O) balance
-
Intermittent electroencephalography (EEG) monitoring (2 times/72 hours)
-
Laboratory data including arterial blood gas analysis (ABGA), complete blood count (CBC), liver function test (LFT), electrolyte, blood urea nitrogen/creatinine (BUN/Cr), et al.
-
SctO2
-
Core (esophageal or bladder) temperature
- Data Collection
Study data will be collected in the following manner:
• All data will be collected on appropriate Case Report Forms.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Active Comparator: 36-TH Core temperature 36℃ of targeted temperature management (36-TH) for 24 hours in cardiac arrest victims using Arctic Sun. |
Device: Arctic Sun
Targeted temperature management for 24 hours with core temperature 36℃ or 33℃
Other Names:
|
Active Comparator: 33-TH Core temperature 33℃ of targeted temperature management (36-TH) for 24 hours in cardiac arrest victims using Arctic Sun. |
Device: Arctic Sun
Targeted temperature management for 24 hours with core temperature 36℃ or 33℃
Other Names:
|
Outcome Measures
Primary Outcome Measures
- The comparison of the 72-hour SctO2 level between the 36-TH and 33-TH groups in cardiac arrest victims [72 hour]
Secondary Outcome Measures
- The comparison of the 72-hour changes in SctO2 level between the 36-TH and 33-TH groups [0, 24, and 72 hours]
- The comparison of the severity scores between the 36-TH and 33-TH groups [0, 24, and 72 hours]
APACHE II score Sequential Organ Failure Assessment (SOFA) score
- The comparison of the serum biomarker levels between the 36-TH and 33-TH groups [0, 24, and 72 hours]
Neuron specific enolase Cytokines Antioxidants
- The comparison of the number of patients with survival discharge between the 36-TH and 33-TH groups [6 months]
- The comparison of the 6-month cerebral performance scale (CPC) between the 36-TH and 33-TH groups [6 months]
- Complication of therapeutic hypothermia [72 hours]
Bleeding requiring transfusion Fatal arrhythmia requiring intervention Electrolyte imbalance: newly developed abnormal values Hyper/hypoglycemia Sepsis/pneumonia
Eligibility Criteria
Criteria
Inclusion Criteria:
- Comatose patients successfully resuscitated from cardiac arrest
Exclusion Criteria:
-
< 18 years old
-
Definite non-cardiac cause arrest
-
Contraindication to TH Active bleeding, coagulopathy, fatal arrhythmia, severe infectious condition
-
Presence of advanced directives to withhold or withdraw life-sustaining treatment
-
Expected survival < 72 hours
-
Underlying low CPC (≤ 3)
-
No informed consent
-
Follow-up loss
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Seoul National University Hospital | Seoul | Korea, Republic of | 03080 |
Sponsors and Collaborators
- Seoul National University Hospital
- Bard Ltd
Investigators
- Principal Investigator: Gil Joon Suh, MD, PhD, Seoul National Univerisity College of Medicine
Study Documents (Full-Text)
None provided.More Information
Publications
- 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. Erratum in: N Engl J Med 2002 May 30;346(22):1756.
- Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Åneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Køber L, Langørgen J, Lilja G, Møller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H; TTM Trial Investigators. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013 Dec 5;369(23):2197-206. doi: 10.1056/NEJMoa1310519. Epub 2013 Nov 17.
- SNUH0620160330