Blood Pressure and Cerebral Blood Flow After Cardiac Arrest
Out-Of-Hospital Cardiac Arrest, Post-Cardiac Arrest Syndrome
About this trial
This is an interventional basic science trial for Out-Of-Hospital Cardiac Arrest focused on measuring Out-Of-Hospital Cardiac Arrest, Blood pressure, Cerebral blood flow, Cerebral metabolism, Cardiac output, Noradrenaline, Post-Cardiac Arrest Syndrome
Eligibility Criteria
Inclusion Criteria:
- Patients who are resuscitated within the last 48 hours after OCHA due to suspected or confirmed cardiac cause.
- Comatose or sedated (Glasgow Coma Score < 8 whereby the patient is unable to follow verbal commands).
- Age 18-90 years.
Exclusion Criteria:
- Patients that have had in-hospital cardiac arrest.
- Pregnancy, human chorionic gonadotropin is routinely measured in women < 60 years of age.
- Known hemorrhagic diathesis (medically induced coagulopathy due to blood thinners is not an exclusion criteria, except for those mentioned below).
- Anticoagulant therapy by warfarin with an INR > 2, Direct-Acting Oral Anticoagulants, or Eptifibatid.
- Suspected or confirmed stroke.
- Non-witnessed cardiac arrest with asystole as the initial rhythm.
- Known treatment limitation plan or a decision not to resuscitate the patient in case of a new cardiac arrest.
- Previous disease that makes 180 day survival unlikely.
- Known Cerebral Performance Category score 3 to 4 prior to cardiac arrest.
- Systolic blood pressure < 80 mmHg despite optimal fluid-, vasopressor-, and inotropic treatment.
- The need of noradrenaline infusion exceeding 0.3 μg/kg*min in order to maintain a MAP of 65 mmHg.
- Mechanical cardiac support devices.
- Known vascular disease in the internal carotid artery.
- Lack of visualization of the internal carotid artery, e.g. due to high placement of the bifurcation.
Sites / Locations
- RigshospitaletRecruiting
Arms of the Study
Arm 1
Experimental
Intervention
Changes in mean arterial pressure (MAP). In all subjects MAP is temporally adjusted using noradrenaline to the following three levels: MAP 65 mmHg. MAP 80 mmHg. MAP 95 mmHg. When MAP has been stable at the given level for 20 min, measurements are conducted over 5 min. When the measurements are done, the study is finished. The study will last approximately 2 hours. Measurements include internal carotid and vertebral artery blood flow, mean arterial pressure, heart rate, peripheral O2 saturation, cardiac output, left ventricle ejection fraction, frontal lobe and muscle oxygenation, blood velocity in the middle cerebral artery, pupillometry, and arterial, central venous, and internal jugular venous gas variables and blood samples for analysis of metabolomics.