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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT06048796
Other study ID # SELECT
Secondary ID NL84714.100.23
Status Recruiting
Phase N/A
First received
Last updated
Start date March 12, 2024
Est. completion date October 2026

Study information

Verified date May 2024
Source Medisch Spectrum Twente
Contact Marleen C. Tjepkema-Cloostermans, PhD
Phone 0031 534872850
Email m.tjepkema-cloostermans@mst.nl
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The objective of this study is to estimate the feasibility and safety of early weaning from ICU treatment in patients after cardiac arrest and an early (< 12 h) favourable EEG pattern (indicating no or mild postanoxic encephalopathy).


Description:

Comatose patients after cardiac arrest are treated on intensive care units with sedative medication, targeted temperature management (TTM), mechanical ventilation, and hemodynamic support. Despite substantial variation in the severity of the encephalopathy and even lack of unequivocal evidence of efficacy of sedation and TTM, all patients receive standard treatment. The severity of the postanoxic encephalopathy can reliably be assessed with the electroencephalogram (EEG). A continuous EEG pattern within the first 12 hours after cardiac arrest ("favorable EEG") is strongly associated with a good neurological outcome and reflects a very mild or transient encephalopathy. The investigators hypothesize that this subgroup of patients, with a favorable EEG will not benefit from prolonged sedation and TTM. The objective of this study is to estimate the feasibility and safety of early weaning from ICU treatment in patients after cardiac arrest and an early (< 12 h) favourable EEG pattern. The study design is a cluster randomized crossover design with two treatment arms. The intervention contrast will be early cessation of sedation and TTM, with subsequent weaning from mechanical ventilation if appropriate (intervention group) vs. standard care, including sedation and TTM for at least 24-48 hours (control group). The investigators will include forty adult patients admitted to the ICU with postanoxic encephalopathy after cardiac arrest and an early (<12 hours) favorable EEG pattern.


Recruitment information / eligibility

Status Recruiting
Enrollment 40
Est. completion date October 2026
Est. primary completion date October 2026
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Patients after cardiac arrest admitted to the ICU for treatment with sedation, TTM and mechanical ventilation. - Age 18 years or older. - Continuous EEG measurement started within 12 hours after cardiac arrest. - Favourable EEG pattern within 12 hours after arrest, defined as a continuous background pattern (NVN, 2019; Ruijter et al., 2019). - Possibility to stop sedative treatment within three hours after identification of a favourable EEG pattern. - Written informed consent (deferred). Exclusion Criteria: - A known history of another medical condition with limited life expectancy (<6 months). - Any progressive brain illness, such as a brain tumour or neurodegenerative disease. - Pre-admission Glasgow Outcome Scale Extended score of 4 or lower. - Reason other than neurological condition to continue sedation and/or ventilation. - Follow-up impossible due to logistic reasons.

Study Design


Intervention

Other:
Early cessation of sedation and TTM
Early cessation of sedation and TTM, with subsequent weaning from mechanical ventilation if appropriate

Locations

Country Name City State
Netherlands Rijnstate hospital Arnhem Gelderland
Netherlands Medisch Spectrum Twente Enschede Overijssel

Sponsors (3)

Lead Sponsor Collaborator
Medisch Spectrum Twente Rijnstate Hospital, University of Twente

Country where clinical trial is conducted

Netherlands, 

Outcome

Type Measure Description Time frame Safety issue
Primary Mechanical ventilation time in hours During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).
Secondary Length of ICU stay During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).
Secondary Total sedation time During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).
Secondary Need for re-intubation During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).
Secondary Need for restarting sedation During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).
Secondary Number of serious adverse events (SAEs) at 3 and 6 months
Secondary Mortality at 30 days, 3 months and 6 months
Secondary Complications during intensive care admission Number of pneumonia, sepsis (according to sepsis 3 criteria), bleeding (any cause), cardiac arrhythmia (any associated with hemodynamic compromise), new cardiac arrest and thrombopenia During the complete ICU admission (from admission to the ICU until discharge from the ICU, up to 30 days).
Secondary Neurological outcome measured at the Extended Glasgow Outcome Scale (GOSE) The CPC ranges from 1 to 8, with higher scores meaning better neurological outcome. at 3 and 6 months
Secondary Neurological outcome measured at the Cerebral Performance Category (CPC) The CPC ranges from 1 to 5, with higher scores meaning worse neurological outcome. at 3 and 6 months
Secondary Cognitive functioning Montreal Cognitive Assessment (MOCA) score via videoconference. The MOCA ranges from 0 to 30, with higher scores meaning better cognitive functioning. at 3 and 6 months
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