In-hospital Cardiac Arrest - Dynamics and State Transitions

Study Overview
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Brief Summary
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The purpose of this study is to analyse transitions in cardiac rhythm and hemodynamic variables during resuscitation of patients with in-hospital cardiac arrest.

Detailed Description
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In-hospital cardiac arrest carries a grave prognosis, with survival to discharge in the range of 15-20%. Key factors determining outcome include the presenting cardiac rhythm, aetiology, and early initiation of resuscitation. Some cardiac rhythms benefit from defibrillation (shockable rhythms). During resuscitation patients may switch between shockable and non-shockable rhythms, and may show signs of spontaneous circulation temporarily. Depending on rhythm and according to guidelines, patients receive direct current (DC) shocks (defibrillator) and/or i.v. adrenaline, atropine and amiodarone, which may affect state-transitions. We wish to make statistical analysis (time-series analysis, Markov modelling) of these state-transitions and variations in hemodynamic variables during resuscitation, related to CPR interventions and the cause of arrest. The cause of arrest will be determined based on chart records, interview with staff and autopsy if appropriate. One hypothesis is that differences in the patterns of state-transitions may reflect underlying aetiology, which may guide in future decision-making during resuscitation.

Official Title
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Dynamics and State Transitions During Resuscitation in In-hospital Cardiac Arrest

Conditions
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Heart Arrest, Death, Sudden, Cardiac

Intervention / Treatment
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* Procedure: Cardiopulmonary resuscitation (CPR)
* Drug: Epinephrine
* Drug: Atropine
* Drug: Amiodarone
* Device: External defibrillator


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with in-hospital cardiac arrest who are resuscitated Exclusion Criteria: Younger than 18 years old

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Cardiopulmonary resuscitation (CPR)|CPR is performed according to international and national guidelines on all patients.|
|Drug: Epinephrine|According to guidelines epinephrine 1 mg i.v. is administered every 3 minutes during cardiopulmonary resuscitation.|
|Drug: Atropine|According to CPR guidelines atropine 3 mg i.v. is administered if asystole og PEA with frequency < 60 beat/min.|
|Drug: Amiodarone|According to guidelines amiodarone 300 mg i.v. is administered if recurrent ventricular fibrillation/tachycardia (VF/VT) during CPR.|
|Device: External defibrillator|According to CPR guidelines patients with shockable rhythms may receive DC shocks. The defibrillator also stores physiological information regarding cardiac rhythm, pulse-oximetry, and end-tidal carbon dioxide (CO2) from endotracheal tube.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Survival to discharge |  | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short-term survival |  | minutes-days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Resuscitation, Cardiac arrest, State-transitions, Markov