Evaluation of Early Prognosis Factors of Neurological Evolution After Resuscitated Cardiac Arrest in Adults
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Cardiac Arrest
- Sponsor
- Centre Hospitalier Régional Metz-Thionville
- Enrollment
- 500
- Locations
- 1
- Primary Endpoint
- Cerebral Performance Categories (CPC) score
- Status
- Suspended
- Last Updated
- 2 years ago
Overview
Brief Summary
Sudden cardiac arrest (CA) in adults remains a major public health issue in industrialized countries, leading to a mortality rate greater than 90%. The analysis of French data estimates the number of sudden deaths at around 40,000 per year. The incidence rate for non-hospital CAs is 55 per 100,000 every year with an immediate survival rate of 9% and 4.8% at one year.
Detailed Description
Approximately 80 % of patients who survive CA with cardiopulmonary resuscitation are comatose. The longer it lasts, the lower chances of recovery. The evaluation of the neurological prognosis of these patients is an important issue. Indeed, 72% of patients admitted to an intensive care unit after resuscitation from CA will give rise to an ethical discussion with the family. The prognostication strategy is usually based on a multimodal process involving clinical examination, electro-neurophysiological and biological examinations. We plan to study the relevance of early neurological prognostic tests in the aftermath of CA and in particular the most recent techniques such as the use of a clinical score (CAHP for Cardiac Arrest Hospital Prognosis), automated infrared pupillometry (NEUROLIGHT ALGISCAN, IDMED) for pupillary reflex measurement and quantitative analysis of the continuous amplitude-integrated electroencephalogram (aEEG) BRAIN QUICK ICU LINE, MICROMED. These new prognostic criteria for CA (CAHP score, pupillometry and aEEG) developed separately have not yet been integrated into a multimodal strategy. The goal of this study is to evaluate the performance of CAHP score, infrared automated pupillometry and aEEG to predict as early as 24h from ROSC the neurological prognosis (Cerebral Performance Categories) at hospital discharge.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Admission in Intensive Care Unit (ICU) following cardiac arrest with ROSC
Exclusion Criteria
- •Minor patient
- •Cardiac arrest (CA) occuring in ICU
- •Decision before ICU admission to withdraw life-sustaining treatments
- •Patient with post-ROSC Glasgow Coma Score = 15
Outcomes
Primary Outcomes
Cerebral Performance Categories (CPC) score
Time Frame: Day 1
The Cerebral Performance Categories (CPC) score is evaluated by a physician at hospital discharge (CPC baseline assessed on basal statut before CA). Good neurological outcome defined as CPC \<3. CPC 1: no or minor disability (conscious and independent, able to work and lead a normal life. May have mild dysphasia, non-incapacitating hemiparesis, or minor cranial nerve abnormalities). CPC 2: Moderate disability (Conscious and independent, able to travel by public transport and work in sheltered environment, independent in activities of daily life. May have hemiplegia, seizures, ataxia, dysarthria or memory changes). Poor neurological outcome defined as CPC 3-5. CPC 3: severe disability (conscious but dependent, limited cognition, dementia, locked-in, minimally conscious. Usually in institution, but sometimes looked after at home with exceptional family effort). CPC 4: unconscious (persistent vegetative state). CPC 5: dead (certified brain dead or traditional criteria).
Secondary Outcomes
- Cardiac Arrest Hospital Prognosis (CAHP) Score(Day 1)
- Neuron Specific Enolase (NSE) plasmatic levels(Day 3)
- Pupillary light reflex surveillance with automated infrared pupillometry(Day 1)
- Amplitude-integrated electroencephalography (aEEG)(Day 1)