Asystole Clinical Trial
Official title:
Neurological Outcomes After Cardiac Arrest in Pulseless Electrical Activity in Comparison to Asystole. Are All Non-shockable Rhythms the Same?
After successful resuscitation from certain types of cardiac arrest, total body cooling is
now a well established treatment that improves the chances of the brain recovering. This
however, has only been definitively proven after a certain type of cardiac arrest that is
"ventricular fibrillation / ventricular tachycardia". The purpose of this study is to
explore if total body cooling is beneficial for patients recovering from another type of
cardiac arrest that is "pulseless electrical activity".
HYPOTHESIS:
Patients undergoing post-cardiac arrest therapeutic hypothermia have better neurological
outcomes if their initial arrest rhythm is pulseless electrical activity (PEA) in comparison
to asystole.
STUDY RATIONALE AND BACKGROUND INFORMATION:
After successful resuscitation from cardiac arrest the body experiences a period of global
reperfusion. During this period, patients may show signs of myocardial stunning, lactic
acidosis, neurological injury and reperfusion syndrome. This constellation of findings
constitutes what is known as post-cardiac arrest syndrome. The brain appears to be one of
the most vulnerable organs to injury during this reperfusion phase and varying degrees of
cognitive impairment may be the end result. Inducing mild therapeutic hypothermia has been
shown to be protective for the brain in this setting and has been demonstrated to improve
neurological recovery. The evidence for this however, is only conclusive in cases where the
arrest is in a shockable rhythm i.e. pulseless ventricular tachycardia and ventricular
fibrillation.
In 2002, two randomized controlled trials were published showing an improvement in
neurological outcomes in patients treated with mild therapeutic hypothermia post
resuscitation from shockable cardiac arrest. Therapeutic hypothermia has since been widely
adopted by most authorities as part of the comprehensive treatment bundle for post cardiac
arrest syndrome. Whether there is any benefit for patients arrested in non-shockable rhythms
however, is a matter of controversy. Some have reported improved mortality and better
neurological outcomes with therapeutic hypothermia in this patient population. Others have
reported no benefit or even a trend towards harm. And although the matter remains
controversial, the recommendation still stands for therapeutic hypothermia to be offered for
all comatose survivors of cardiac arrest whatever the arrest rhythm.
Most previous reports have examined the differences between shockable and non-shockable
rhythms in terms of neurological outcome and mortality rates after therapeutic hypothermia.
To our knowledge, no study has examined the differences in outcome between the two types of
non-shockable rhythms, that is pulseless electrical activity (PEA) and asystole. We
hypothesize that during PEA arrests, patients may retain some degree of cerebral perfusion
and hence have better neurological outcomes post-resuscitation. That is in contrast to
asystole where patients are likely to have no cerebral perfusion. In this study we attempt
to detect any possible differences in neurological recovery (as indicated by the Cerebral
Performance Category scale on hospital discharge) after therapeutic hypothermia, between
patients arrested in PEA arrest and those arrested in asystole.
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Observational Model: Cohort, Time Perspective: Retrospective
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