View clinical trials related to Out-of-hospital Cardiac Arrest.
Filter by:This study examines the impact of emergency department (ED) management on short-term outcomes of nontraumatic adult out-of-hospital cardiac arrest (OHCA) patients. Conducted by a research team at National Taiwan University Hospital and its affiliated hospitals, including branches in Hsinchu and Yunlin, the study spans from January 2016 to August 2023. It focuses on a sequential population of patients, analyzing data like age, gender, medical history, prehospital care details (e.g., witnessed collapse, bystander CPR), and specifics of ED management. OHCA, with an incidence rate of 50-100 per 100,000 people, presents high mortality and severe complications, leading to significant healthcare expenditures. After resuscitation in the ED, only about one-fifth of patients achieve return of spontaneous circulation (ROSC). The prognosis for these patients remains grim, with a mere 5% experiencing favorable neurological outcomes. Understanding the mechanisms of OHCA, identifying risk factors, effective interventions, and the timing of ED treatments like vasopressors and electrocardiography are crucial. Patients post-OHCA often undergo a postcardiac arrest syndrome (PCAS), marked by cellular hypoxia and a consequential inflammatory response. Stability of vital signs and rapid ED interventions, including identifying OHCA causes and coordinating with specialists, are vital for short-term recovery. This study aims to determine if ED management and time-related factors from ROSC to various interventions (e.g., ECG, CT scans) affect short-term survival rates, including survival to hospital admission and survival after 1, 3, and 7 days. By retrospectively analyzing patient data, including Utstein Style prehospital cardiac arrest registry variables and emergency department management details, the study seeks to shed light on the crucial phase of post-resuscitation care. The ultimate goal is to improve survival rates and neurological outcomes in OHCA patients, emphasizing the need for more comprehensive research in this area
The purpose of the research (pilot study) is to determine the impact of the use of the autotransfusion device on hemodynamic parameters during resuscitation. 24 people will be included in the pilot study (12 people will be included in the intervention group - with the usage of "autotransfusion socks" during resuscitation and 12 people in the control group - without "autotransfusion socks"). Investigators will compare the hemodynamic parameters and also neurological outcome between both groups.
To determine the clinical effectiveness of hypothermia treatment in patients with out-of-hospital cardiac arrest complicating acute myocardial infarction.
The goal of this observational study is to establish the protocol of systemic analysis of the causes of non-traumatic cardiac arrest in young patients. The main questions it aims to answer are: - Whether the protocolized classification of cardiac arrest minimizes the proportion of unknown causes and mis-classification in young cardiac arrest patients? - Whether the incorporation of genetic tests in the identification protocol of arrest cause helps the recognition of sudden arrhythmic death syndrome in young cardiac arrest patients? Participants will be asked to received serial examinations including genetic analysis to explore the cause of cardiac arrest.
This study aims to optimize the treatment of out-of-hospital cardiac arrest (OHCA) by focusing on neurological outcomes through Bispectral Index (BIS) monitoring. It will evaluate the feasibility of BIS monitoring in the prehospital phase, assess the need for sedation based on BIS values, and examine the timing of interventions in ICU (intensive care unit) settings to identify irreversible Hypoxic-Ischemic Brain Injury (HIBI).
This study will assess the feasibility of performing pre-hospital resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to conventional Advanced Life Support (ALS) in patients suffering from non-traumatic out of hospital cardiac arrest (OHCA). As well as providing valuable insights into the technical feasibility of performing this procedure as part of a resuscitation attempt, the study will also document the beneficial physiological effects of REBOA in this group of patients.
The goal of this randomized controlled trial is to compare prehospital ventilation strategies in out-of-hospital cardiac arrest. The intervention group is automatic ventilation and the control group is manual ventilation. The main questions it aims to answer are: 1. How does automatic ventilation affect OHCA patients' survival and prognosis comparing to manual ventilation. 2. What are the differences on resuscitation qualities between automatic ventilation and manual ventilation.
Extra-hospital cardiac arrest is a major public health problem, with approximately 46,000 cases per year. Nearly 71% of the patients for whom resuscitation was initiated did not present a return of spontaneous circulation on scene and only 29% were transported alive to the hospital. In this context, extracorporeal cardiopulmonary resuscitation (ECPR) by veno-arterial extracorporeal membrane oxygenation has been developed as a second line of treatment according to the latest international guidelines. The selection of eligible patients as well as the timing of initiation of ECPR has long been controversial, but expert recommendations have recently been published. After an out-of-hospital cardiac arrest of cardiological cause, an early ventricular dysfunction has been previously described, more particularly in hemodynamically unstable patients. This dysfunction was associated with greater early in-hospital mortality. There are few data on the medium-term course of left ventricular dysfunction and the largest study addressing this question showed that the severity of left ventricular involvement was associated with greater long-term morbidity and mortality. However, it also found that left ventricular ejection fraction was partially reversible in 29% of the study population. It seems so far, the medium-term evolution of left heart dysfunction had not been described in the context of refractory extra-hospital cardiac arrest treated by ECPR. However, these patients are particularly severe, hemodynamically unstable and potentially at risk of developing long-term sequelae.
In the course of prehospital respiratory and circulatory arrest, approximately 1000 persons are resuscitated by cardiopulmonary resuscitation in Upper Austria every year. Despite constant further development of methods, equipment and continuous training of the rescue and emergency medical teams working on site, the majority of patients who have to be resuscitated prehospital still die. However, even patients whose circulatory function can be restored during prehospital resuscitation (Return of Spontaneous Circulation, ROSC) require intensive medical care for days to weeks and often find it very difficult to return to a normal, independent life. The success of resuscitation measures depends on the quality of the resuscitation performed as well as on patient-specific factors. Evaluation scales such as the Cerebral Performance Category score (CPC) allow a posteriori assessment of resuscitation success. Nowadays, it is very difficult to estimate the outcome of resuscitation a priori. In many cases, it is not at all clear at the beginning of the treatment pathway whether the individual patient is expected to have an unfavorable prognosis in the context of respiratory arrest or whether a restitutio ad integrum is possible. Thus, the decision to continue or discontinue resuscitation can only be made on the basis of an individual physician's assessment. In addition to the primary concern of stopping resuscitation too early, there is also the risk that medical resources are used beyond the normal level after resuscitation without expecting a successful outcome. Estimating and categorizing the subsequent outcome is difficult and emotionally stressful for the treating team in the acute situation. Some factors that influence outcome are now known: As cerebral hypoperfusion increases, the probability of survival decreases sharply with each passing minute. In this context, potentially reversible causes have been identified in different works, allowing causal therapy to improve neurological outcome. In addition to the most important therapy bridging hypoperfusion, chest compression, with the aim of ensuring minimal perfusion of the brain, immediate defibrillation should be mentioned in particular, which now allows medical laypersons to use defibrillators as part of the Public Access Defibrillation Network. Despite all efforts, however, it is not yet possible to make reliable statements about the probable outcome of persons with respiratory and circulatory arrest with a high degree of certainty in a large number of cases at an early stage. Artificial intelligence refers to the ability of machines to perform cognitive tasks, such as recognizing objects in images and classifying them. For a long time, many processes were too complex to explore through sufficient computing power, storage capacity, and understanding. More recently, however, technological advances have brought machine learning (ML) and the constructs behind it, including those based on so-called neural networks (known since about 1950), back to the fore. Not only the development of theoretical models, but after extensive testing also devices applicable in daily routine operation are available. Modern machine learning methods are enabling a variety of new approaches to assessing operations, including modeling complex systems and finding relationships between models.
The aim of this clinical trial is to study the impact of ultra-early transnasal evaporative cooling after cardiac arrest and subsequent hypothermia at hospital, on survival with complete neurologic recovery, compared to currently recommended normothermia. The study population will consist of patients 18-79 years old, with out-of-hospital cardiac arrest with initial shockable rhythm. The main research question it aims to answer is whether there is a difference in survival with complete neurologic recovery at 90 days after cardiac arrest between the group of patients that received ultra-early cooling, compared to the group that was treated with normothermia. Participants will be randomized to two groups. One group (the intervention group) will receive ultra-early trans-nasal evaporative cooling initiated by EMS personnel at the scene of the cardiac arrest, and subsequent systemic hypothermia for 24 hours at hospital arrival. The other group (the control group), will receive standard of care (advanced cardiac life support and normal body temperature (normothermia)).