Clinical trial NCT02066753: The Cardiac Effects of Prolonged Hypothermia After Cardiac Arrest
Official title: The Cardiac Effects of Prolonged Hypothermia After Cardiac Arrest
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Cardiac Arrest
Hypothermia
Keywords: Cardiac arrest
Therapeutic Hypothermia
Cardioprotectiveness
Hemodynamics
Lead sponsor: University of Aarhus
Sponsor class: OTHER
First posted: 2014-02-19
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This PhD study is a sub study in a randomized clinical controlled multicenter trial named "TTH48" (ClinicalTrials.gov Identifier: NCT01689077).

The TTH48 trial examines prolonged mild therapeutic hypothermia ("MTH") at 32-34°C in 24 versus 48 hours with the primary outcome Cerebral Performance Category after 6 month in comatose out-of-hospital cardiac arrest patients.

THE OVERALL AIM OF THIS PhD STUDY IS TO INVESTIGATE THE CARDIAC FUNCTION AND THE HEMODYNAMICS BY BIOCHEMICAL CARDIAC MARKERS, ECHOCARDIOGRAPHY, BY ANALYZING THE USAGE OF INOTROPES/VASOPRESSORS AND BY ANALYZING ECG DATA FOR ARRHYTHMIAS IN THE 24 VERSUS 48 HOURS MTH GROUPS.

Detailed description: The PhD-study contains 3 sub studies:

* Study 1 estimates the extend of myocardial damage resulting from the primary arrest and from the reperfusion injuries: Area under the curve of cTnT and CK-MB as 12 repeated measurements and NT-proBNP as 4 measurements post arrest

  -Hypothesis: There is a statistically significantly greater release of the cardiac biomarkers cTnT and NT-proBNP quantified by the area under the curve in the 24 versus the 48 hours group in the intervention period from 24 to 72 hours.
* Study 2 investigates MTH´s influence on systolic and diastolic function by standard and Tissue Doppler (TDI) echocardiography after 24, 48 and 72 hours. The primary endpoint is mitral annular systolic velocity ("S´ max")

  -Primary hypothesis: There is statistically significant improvement in S' max from the time T24 to T72 in the 48 versus the 24 hours group.

  -Secondary hypothesis: There is statistically significantly better systolic function at T48 measured in terms of individual S' max-change in the 48 hours group (still hypothermic) versus the 24 hours group (reached normothermia).
* Study 3 investigates MTH´s influence on the need for vasopressor or inotrope and the duration of arrhythmias during the first 72 hours post arrest.

  * Primary hypothesis: There is a statistically significantly increased tendency of arrhythmias in the 48 versus the 24 hours group measured in the period from T0 to T72.
  * Secondary hypothesis: There is a statistically significantly reduced need for inotropes in the 48 versus the 24 hours group measured by cumulative vasopressor index in the period from T0 to T72.

Eligibility criteria: Inclusion Criteria:

1. Resuscitated after cardiac arrest outside hospital with suspected cardiac triggering cause (and stabile circulation for at least 20 minutes after return of spontaneous circulation,
2. Glasgow coma score \< 8 and
3. Age ≥ 18 years and \< 80 years.

Exclusion Criteria:

1. Cardiac arrest of suspected non-cardiac triggering cause (e.g. trauma, aortic dissection, massive bleeding, hypoxia or accidental hypothermia),
2. \>60 minutes from cardiac arrest to ROSC,
3. Time from cardiac arrest until start of cooling \>4 hours,
4. Terminal illness,
5. Coagulopathy (medical anticoagulation treatment including thrombolysis is not a contraindication),
6. Unwitnessed arrests with asystolia as presenting rhythm,
7. Pregnancy,
8. Persistent cardiogenic shock,
9. Systolic blood pressure \<80 mmHg despite vasoactive treatment and intra-aortic balloon pump
10. CPC 3-4 before the cardiac arrest,
11. Suspected/confirmed acute intra cerebral hemorrhage or stroke,
12. Acute CABG or other operation in connection with performing CPR,
13. Lack of consent from the relatives,
14. Lack of consent from the GP and
15. Lack of consent from the patient if he/she wakes up and is relevant.

Primary outcomes:
measure: Area under the curve cTnT
timeFrame: In the intervention period from 24 to 72 hours
measure: Mitral annular systolic velocity
timeFrame: After 24 hours, 48 hours and 72 hours
measure: Duration of arrhythmias
timeFrame: From target temperature (32-34°C) has been reached until 72 hours after
measure: Cumulative vasopressor index
timeFrame: From target temperature (32-34°C) has been reached until 72 hours after
Secondary outcomes:
measure: Area under the curve NT-proBNP
timeFrame: In the intervention period from 24 to 72 hours
Other outcomes:
Locations:
city: Aarhus N
country: Denmark
facility: Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Skejby
state: Central Denmark Region
city: Stavanger
country: Norway
facility: Research Center of Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, Stavanger University Hospital
Study officials:
affiliation: Research Center of Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Skejby, Denmark
name: Anders Grejs, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Jensen TH, Juhl-Olsen P, Nielsen BRR, Heiberg J, Duez CHV, Jeppesen AN, Frederiksen CA, Kirkegaard H, Grejs AM. Echocardiographic parameters during prolonged targeted temperature Management in out-of-hospital Cardiac Arrest Survivors to predict neurological outcome - a post-hoc analysis of the TTH48 trial. Scand J Trauma Resusc Emerg Med. 2021 Feb 19;29(1):37. doi: 10.1186/s13049-021-00849-7.
citation: Grejs AM, Nielsen BRR, Juhl-Olsen P, Gjedsted J, Sloth E, Heiberg J, Frederiksen CA, Jeppesen AN, Duez CHV, Hamre PD, Soreide E, Kirkegaard H. Effect of prolonged targeted temperature management on left ventricular myocardial function after out-of-hospital cardiac arrest - A randomised, controlled trial. Resuscitation. 2017 Jun;115:23-31. doi: 10.1016/j.resuscitation.2017.03.021. Epub 2017 Apr 2.