In-hospital Cardiac Arrest - Dynamics and State Transitions

Heart Arrest Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00920244
• Other study ID #: 4.2008.2402 (REK)
• Secondary ID: 08/1145720708/2/
• Status: Completed
• Start date: August 2009
• Est. completion date: April 2015

Study information

• Verified date: August 2018
• Source: St. Olavs Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

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

Description:

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 285
• Est. completion date: April 2015
• Est. primary completion date: April 2015
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patients with in-hospital cardiac arrest who are resuscitated

Exclusion Criteria:

• Younger than 18 years old

Related Conditions & MeSH terms

• Death, Sudden
• Death, Sudden, Cardiac
• Heart Arrest

Intervention

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.
• Atropine
According to CPR guidelines atropine 3 mg i.v. is administered if asystole og PEA with frequency < 60 beat/min.
• 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.

Locations

Country	Name	City	State
Norway	St.Olavs Hospital, Department of Anesthesia	Trondheim

Sponsors (3)

Lead Sponsor	Collaborator
St. Olavs Hospital	Norwegian Air Ambulance Foundation, Norwegian University of Science and Technology

Country where clinical trial is conducted

Norway, 

References & Publications (1)

Skjeflo GW, Nordseth T, Loennechen JP, Bergum D, Skogvoll E. ECG changes during resuscitation of patients with initial pulseless electrical activity are associated with return of spontaneous circulation. Resuscitation. 2018 Jun;127:31-36. doi: 10.1016/j.r — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Survival to discharge		1 year
Secondary	Short-term survival		minutes-days