Unexpected Cardiac Arrest in Intensive Care Unit

Completed

Conditions: Heart Arrest

Registration Number: NCT03021564

Lead Sponsor: Groupe Hospitalier de la Rochelle Ré Aunis

Brief Summary: Unexpected cardiac arrest involves approximately 0.5 to 5% of patients admitted in Intensive Care Unit (ICU). Even if they have a technical environment conducive to prompt diagnosis and prompt treatment, patients hospitalized in ICU suffer from chronic illnesses and organ failure(s) that obscure the prognosis of cardiac arrest. Although extra cardiac arrhythmias or intra-hospital arrests are the subject of numerous publications, few studies specifically focus on unexpected cardiac arrest in ICU (none in France). The objective of our work is to produce a prospective epidemiological description of unexpected cardiac arrest in in French ICUs.

Detailed Description: Unexpected cardiac arrest in ICU corresponds to cardiovascular arrest leading to at least one cardiopulmonary resuscitation technique (external cardiac massage and / or electric shock). They account for about 0.5 to 5% of admissions to intensive care units. Even if they benefit from a technical environment conducive to prompt diagnosis and rapid management, Resuscitated patients suffer from chronic diseases and organ failure (s) that darken the prognosis. Etiologies of unexpected cardiac arrest in ICU are rarely described in the literature. Their specificity comes from the fact that they can be related to patient's medical characteristics, but also to deleterious effects of supportive techniques in place at the time of circulatory arrest (respiratory assistance, vasopressor drugs, extracorporeal circulation ...). These same techniques may also reduce the effectiveness of cardiopulmonary resuscitation (cardiorespiratory interactions of respiratory assistance, pro-arrhythmogenic effect of vasopressor drugs, haemodynamic repercussion of extracorporeal circulation). Although cardiac arrests have been published extensively out of or in-hospital, there are few studies specifically concerning unexpected cardiac arrest in ICU (none in France). The prognosis is different: after an unexpected cardiac arrest in ICU, 50% of the patients recover a spontaneous cardiac activity but only 15% leave alive from the hospital (3 to 4% with a good functional autonomy). A prospective description of risk factors, circumstances and consequences in the medium term would identify (and prevent) risky situations and identify, among those at risk for unexpected cardiac arrest, those for whom a cardiopulmonary resuscitation is justified.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 677

Inclusion Criteria

Patient with unexpected cardiac arrest during his / her hospitalization in the ICU
Patients who have benefited from at least one basic cardiopulmonary resuscitation technique by the ICU team to treat this circulatory arrest (external electric shock, external cardiac massage, adrenaline injection ...)
Patients with multiple unexpected cardiac arrest during hospitalization will be included only for the first circulatory arrest.

Exclusion Criteria

Patients with unexpected cardiac that have not been resuscitated.
Patients in cardiac arrest at admission to ICU

Study & Design

Study Type: OBSERVATIONAL

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Number of Patients With Unexpected Cardiac Arrest	1 year	Number of patients with at least one cardiac arrest in intensive care with attempted cardiopulmonary resuscitation as a proportion of total admissions.

Secondary Outcome Measures

Name	Time	Method
Number of Patients Per Reason for ICU Admission	1 year	Number of patients admitted to ICU with either Medical (vs surgical) reason for admission, circulatory failure, respiratory failure, cardiac arrest, cardiac surgery
History, Comorbidities Before Unexpected Cardiac Arrest	1 year	High blood pressure, Diabetes, Dyslipidemia, Tobacco, Ischemic heart disease, Heart disease from another cause, Malignancy, Alcohol, Renal disease, Respiratory disease, Cardiac arrest, Neurological disease, Liver disease
Mc Cabe Score Before Unexpected Cardiac Arrest	1 year	0- absence of underlying disease or non-life-threatening disease 1. underlying life-threatening disease over a period of 5 years 2. underlying disease estimated fatal within 1 year
Knaus Score Before Unexpected Cardiac Arrest	1 year	A- No activity limitation B- Moderate restriction of activity (limited professional activities) C- Major activity restriction but not total D- Major activity restriction, bedridden condition, long-term hospitalization
Organ Failure Score Before Unexpected Cardiac Arrest	1 year	sequential organ failure assessment (SOFA) sub-score ≥ 3 * Respiratory failure: \< 200 fraction of inspired oxygen inspired oxygen fraction (26.7 mmHg \[kilopascal\]) and mechanically ventilated, * Neurological impairment : Glasgow coma scale \<10, * Circulatory failure: dopamine \> 5 μg/kg/min OR epinephrine ≤ 0.1 μg/kg/min OR norepinephrine ≤ 0.1 μg/kg/min, * Hepatic failure: ≥ 6.0-11.9 mg/dl \[102-204 μmol/L\] Bilirubin, * Haematological failure: \< 50 Platelets×103/μl, * Renal failure: ≥ 3.5-4.9 mg/dl \[300-44 0μmol/L\] (or \< 500 ml/d) Creatinine
Number of Participants With Unexpected Cardiac Arrest Etiologies	1 year
Number of Patients With Resumption of Spontaneous Cardiac Activity After Cardiopulmonary Resuscitation	1 year
Cerebral Performance Category Scale at Hospital Discharge	at Hospital Discharge	Cerebral performance category score (CPC) 1. Conscious without neurological deficit or minor deficit 2. Conscious with moderate deficit 3. Conscious with severe deficit 4. Deep Coma or Vegetative State 5. Deceased
Cerebral Performance Category Scale at 6 Months	at 6 months after inclusion (unexpected cardiac arrest)	Cerebral performance category score (CPC) 1. Conscious without neurological deficit or minor deficit 2. Conscious with moderate deficit 3. Conscious with severe deficit 4. Deep Coma or Vegetative State 5. Deceased
Number of Patients With Unexpected Cardiac Arrest, Resuscitated Despite Previous Decision Not to Resuscitate	1 year

Trial Locations

Locations (44): CH Chartres
🇫🇷
Chartres, France
CH Sud Essonnes
🇫🇷
Etampes, France
CHU Grenoble
🇫🇷
Grenoble, France
CHD Vendée
🇫🇷
La Roche sur Yon, France
GH La Rochelle Ré Aunis
🇫🇷
La Rochelle, France
CH Gueret
🇫🇷
Gueret, France
CHU La Réunion
🇫🇷
La Réunion, France
CH Lens
🇫🇷
Lens, France
CHU Lyon
🇫🇷
Lyon, France
GH de l'Institut Catholique de Lille
🇫🇷
Lille, France
CH Melun
🇫🇷
Melun, France
CHU Nantes
🇫🇷
Nantes, France
CHU Nîmes
🇫🇷
Nîmes, France
CHR Orleans
🇫🇷
Orleans, France
APHP Saint Louis
🇫🇷
Paris, France
APHP Cochin
🇫🇷
Paris, France
CH Pau
🇫🇷
Pau, France
Hôpital Paris Saint Joseph
🇫🇷
Paris, France
CH Pontoise
🇫🇷
Pontoise, France
CH Cornouaille
🇫🇷
Quimper, France
CH Versailles
🇫🇷
Versailles, France
CH Roanne
🇫🇷
Roanne, France
CHU Rouen
🇫🇷
Rouen, France
CH Angoulême
🇫🇷
Angouleme, France
CH Niort
🇫🇷
Niort, France
CHU Poitiers
🇫🇷
Poitiers, France
CHU Limoges
🇫🇷
Limoges, France
CH Meaux
🇫🇷
Meaux, France
CHU Brest
🇫🇷
Brest, France
CH Colmar
🇫🇷
Colmar, France
CH Agen
🇫🇷
Agen, France
CH Dieppe
🇫🇷
Dieppe, France
APHP
🇫🇷
Garches, France
CHU Angers
🇫🇷
Angers, France
CH Bourg en Bresse
🇫🇷
Bourg en Bresse, France
CH Béthune
🇫🇷
Bethune, France
CHU Caen
🇫🇷
Caen, France
CH Blois
🇫🇷
Blois, France
GH Carnelle Portes de l'Oise
🇫🇷
Beaumont, France
CH Arras
🇫🇷
Arras, France
CH Angouleme
🇫🇷
Angouleme, France
CH Cahors
🇫🇷
Cahors, France
CH Cholet
🇫🇷
Cholet, France
CHU Dijon
🇫🇷
Dijon, France