Please select the eligibility criteria that correspond to the clinical trial below.
Title: Carbon Dioxide, Oxygen and Mean Arterial Pressure After Cardiac Arrest and Resuscitation - Targeting High vs. Low Normal Values
Brief Summary: The COMACARE trial is a pilot multicenter randomized trial to assess the feasibility and effect on brain injury markers of targeting low or high normal arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2) and mean arterial pressure (MAP) in comatose, mechanically ventilated patients after out-of-hospital cardiac arrest. Using factorial design, participants are randomized at admission to intensive care unit to one of eight groups targeting either low or high normal values of PaO2, PaCO2 and MAP for 36 h. In this way, investigators will be assessing the feasibility and effect of all three variables at the same time.

The primary outcome is serum concentration of neuron-specific enolase (NSE) at 48 h after cardiac arrest. Feasibility outcome is between-group separation in PaO2, PaCO2 and MAP levels. Secondary outcomes include continuous monitoring of cerebral oxygenation, EEG and ECG for 48 h, the levels of NSE, S100B and cardiac troponin at randomization and 24, 48 and 72 h after cardiac arrest and neurological assessment at 6 months after cardiac arrest.


Options:
A: Inclusion Criteria:

* Major patients with mechanical ventilation
* ARDS according to Berlin definition:Hypoxemia defined with PaO2 FiO2 ratio less or equal to 300 mmHg with Positive End Expiratory Pressure higher or equal to 5 cmH20, Less than seven days between a known clinical insult or new or worsening of respiratory symptoms, Bilateral opacities on chest Imaging not fully explained by effusions, lobar or lung collapse, or nodules, Respiratory failure not fully explained by cardiac failure or fluid overload
* Less than twelve hours following initiation of mechanical ventilation.

Exclusion Criteria:

* Pregnancy
* Patient less than 18 years old
* Sickle cell disease
* Patient deprived of freedom, Under a legal protective measure
* Cardiac arrest as the reason for ICU hospitalisation
* Traumatic brain injury as the reason for ICU hospitalisation
* Hemoptysis with embolization or surgery
* Extracorporeal life support or Extracorporeal Membrane Oxygenation before randomization
* Chronic Obstructive Pulmonary Disease with oxygen or non invasive ventilation at home (obstructive sleep apnoea syndrome is not an exclusion criteria)
* Patient with very high risk of death with IGS II (Simplified Severity Index II) than 90
* Indication of hyperbaric oxygenation : carbon monoxide intoxication, gas embolism, necrotizing fasciitis
* Cyanide intoxication, methemoglobinemia
* Untreated pneumothorax
* Lymphangitis carcinomatosa
* Eosinophilic pneumonia
* Intensive care management for organ donation
* Participation in another interventional study with mortality as a major outcome to avoid confounding factor
* Patient not affiliated to social security
B: Inclusion Criteria:

* Age ≥ 18 years, including fertile women\*
* Blunt/Penetrating trauma patient
* Direct transfer from the scene of the accident to Rigshospitalets Traume Center
* Trauma team activation \* There is no added risk for enrolment of fertile women as oxygen administration is approved for this group of patients.

Exclusion Criteria:

* Patients in cardiac arrest before/at admission
* Patients with a suspicion of smoke inhalation
* No hospital admission after initial treatment in trauma center
C: Inclusion Criteria:

* ≥2 positive SIRS-criteria:

  * Temperature \>38 deg.C or hypothermia \<36 deg.C
  * Heart rate \>90 bpm
  * Respiratory rate \>20 /min or pCO2 \<32 mmHg (4.3 kPa)
  * Number of leucocytes \>12 x 10\^9/l of \<4 x 10\^9/l of \>10% bands
* Within 12 hours of admittance to the ICU
* Expected stay of more than 48 hours as estimated by the attending physician

Exclusion Criteria:

* Elective surgery
* Carbon monoxide poisoning
* Cyanide intoxication
* Methemoglobinemia
* Sickle cell anemia
* Severe pulmonary arterial hypertension (WHO class III or IV)
* Known severe Acute Respiratory Distress Syndrome (ARDS) (PaO2/FiO2 ≤100 mmHg and PEEP ≥ 5 cm H2O)
* Known cardiac right to left shunting
* Pregnancy
* Severe Chronic Obstructive Pulmonary Disease (COPD) (Gold class III or IV) or other severe chronic pulmonary disease
* Patients participating in other interventional trials
D: Inclusion Criteria:

* Witnessed out-of-hospital cardiac arrest with ventricular fibrillation (VF) or ventricular tachycardia (VT) as the initial rhythm
* Delay of return of spontaneous circulation (ROSC) 10-45 min from the start of the arrest
* Confirmed or suspected cardiac origin
* Mechanical ventilation
* Markedly impaired level of consciousness (no response to verbal commands and Glasgow coma scale \[GCS\] motor score \< 5)
* Deferred consent possible or likely
* Active intensive care initiated, including targeted temperature management (33-36 C)

Exclusion Criteria:

* Probable withdrawal of active ICU care due to terminal illness or poor prognosis because of severely reduced functional status before cardiac arrest
* Confirmed or suspected intracranial pathology and/or suspicion of raised intracranial pressure
* Pregnancy
* Severe oxygenation problem (PaO2 / FiO2 \< 100 mmHg)
* Severe COPD

Answer: D