Mean Arterial Pressure After Out-of-hospital Cardiac Arrest (METAPHORE)
Cardiac Arrest
About this trial
This is an interventional treatment trial for Cardiac Arrest focused on measuring cardiac arrest, outcome, cerebral blood flow, mean arterial pressure
Eligibility Criteria
Inclusion Criteria:
- Admission to ICU following an out-of-hospital cardiac arrest with an initially shockable or non-shockable rhythm ;
- Sustained ROSC defined as 20 minutes with signs of circulation without the need for chest compressions;
- Under invasive mechanical ventilation for coma, defined as a Glasgow score ≤ 8/15;
- Consent from a relative or of a procedure for emergency inclusion.
Exclusion Criteria:
- Age < 18 years ;
- No-flow duration > 10 minutes or unknown (time between CA and the start of cardiopulmonary resuscitation) ;
- Low-flow duration > 45 minutes (time between the start of cardiopulmonary resuscitation and ROSC) ;
- Unwitnessed CA with initial rhythm of asystole
- Time between ROSC and inclusion > 6 hours ;
- Cardiac arrest in a context of multiple trauma ;
- Cardiac arrest in a context of hemorrhagic shock or severe hemorrhage necessitating hemostasis (surgery or radiological or endoscopic hemostasis) ;
- Cardiac arrest secondary to an acute brain disease (ischemic or hemorrhagic stroke, subarachnoid hemorrhage, severe traumatic brain injury) ;
- Refractory circulatory insufficiency:
Defined as a MAP < 65 mmHg for more than one hour on norepinephrine or epinephrine at a dose > 1 µg/kg/min despite adequate fluid resuscitation ;
- Extracorporeal circulatory support for refractory cardiogenic shock before inclusion ;
- Extracorporeal respiratory support by Extra-Corporeal Membrane Oxygenation (ECMO) for severe acute respiratory distress syndrome before inclusion ;
- Extracoporeal circulatory support before ROSC
- Decision to limit care before inclusion ;
- Modified Rankin score of 4 or 5 before cardiac arrest ;
- Inclusion in another interventional study in which the principal endpoint is neurological prognosis ;
- Pregnancy or breast feeding ;
- Adult patient under legal protection (incapable adult or ward of court) ;
- Patient already included in this trial ;
- Absence of social security cover.
Sites / Locations
- Centre Hospitalier Du Mans
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
high MAP threshold
standard MAP threshold
Norepinephrine will be titrated to maintain MAP ≥ 90 mmHg. This threshold will be maintained for the 24 hours following inclusion by the perfusion of norepinephrine at an appropriate dose. From 24 hours after inclusion until ICU discharge, a MAP ≥ 65 mmHg will be targeted
Norepinephrine will be titrated to maintain MAP ≥ 65 mmHg. This target MAP will be maintained for 24 hours after randomization through the perfusion of norepinephrine at an appropriate flow rate. From 24 hours after inclusion until ICU discharge, a MAP ≥ 65 mmHg will be targeted