Active clinical trials for "Heart Arrest"

This single-center proof of concept study aims to assess the efficacy of a blood pressure strategy targeting person- and time-specific cerebral blood flow compared with standard-of-care using neuron-specific enolase as a quantitative biomarker of brain injury. Our central hypothesis is that an individualized blood pressure strategy targeting cerebral perfusion, compared with standard-of-care, will reduce the extent of brain injury as indicated by changes in levels of neuron-specific enolase from baseline at 72 hours. To test this hypothesis, the investigators will randomly assign 90 patients to an individualized blood pressure management strategy targeting cerebral blood flow, where optimal blood pressure will be serially calculated by the ICM+ brain monitoring software (Cambridge, UK) using inputs from transcranial Doppler ultrasound and near-infrared spectroscopy (intervention), versus achieving a standard level of systemic blood pressure (standard-of-care). This is done in a 2:1 allocation (60 to intervention, 30 to standard-of-care), in the first 72 hours after return of spontaneous circulation (ROSC).

Out-of-hospital cardiac arrest is a public health problem for which overall survival is below 10%. Post-cardiac arrest syndrome is the principal cause of death in intensive care units (ICU), due to refractory shock or brain injuries secondary to anoxia. Brain anoxia is responsible for severe neurological sequelae that may be aggravated by cerebral hypoperfusion during the first few hours after the return of spontaneous circulation. Current recommendations are to ensure that arterial blood pressure is sufficient for the perfusion of organs, but no minimum threshold mean arterial pressure (MAP) has been defined. In practice, most teams target a MAP of at least 65 mmHg. Several observational studies have shown a correlation between MAP and neurological prognosis, patients with a higher initial MAP having a better outcome. Recent pilot studies have demonstrated the feasibility of increasing the target MAP after cardiac arrest, but conflicting results have been obtained concerning patient prognosis. These findings may be explained by changes to the autoregulation of the brain after cardiac arrest, with a shift of the curve towards the right, or its abolition. Cerebral blood flow is dependent on MAP, and a target MAP of 65 mmHg for these patients may result in insufficient brain perfusion. Conversely, a too high MAP might cause brain lesions due to vasogenic edema, hemorrhagic complications or excess perfusion in conditions of diminished brain metabolism. An interventional study is required to evaluate the effect of increasing MAP on neurofunctional outcome after cardiac arrest. Given the data available for brain autoregulation, the correlation between MAP and prognosis, and the risks theoretically associated with a higher MAP, investigator plans to compare a standard threshold of MAP (≥ 65 mmHg) with a high threshold of MAP (≥ 90 mmHg). Investigator hypothesizes that a high MAP within the first 24 hours after cardiac arrest will improve neurofunctional outcome.

Objectives/Hypotheses Prehospital termination-of-resuscitation (TOR) rules were developed in North American and European sites. Whether they remained valid in different geographic, ethnic, and cultural background areas is still under debate. Differences in characteristics of out-of-hospital cardiac arrests (OHCAs) and configurations of emergency medical service (EMS) between the Western and Asian countries, including relatively lower rate of presenting shockable rhythm (i.e. ventricular fibrillation / ventricular tachycardia; VF/VT), lower rates of bystander CPR, less advanced life support (ALS) implementation, and less public access defibrillators, might create potential threats to the prediction accuracy of TOR rules. We aim to conduct a study to validate the performance of ever published TOR rules in Asian OHCA population, including non-traumatic, traumatic, and pediatric OHCA patients. Furthermore, assess the possible variables that may impact the performance of TOR rules. We also aim to develop new TOR rules based on PAROS registry for Asia population, focusing on non-traumatic, traumatic, and pediatric OHCA patients, respectively.

The purpose of this pilot feasibility study is to evaluate the ability of the Perfusion Index to predict the return to spontaneous circulation of the out-of-hospital cardiac arrest patient during cardiopulmonary resuscitation. The performance of the perfusion index will also be compared to the current gold standard, end-tidal CO2 (EtCO2).

Our general objective, during this study, is to evaluate the feasibility and potential physiological benefits of using REBOA (resuscitative endovascular balloon occlusion of the aorta) CPR (cardiopulmonary resuscitation) for patients presenting with a cardiac arrest to a community hospital. This would represent the first step for doing a larger, randomized clinical trial on the use of REBOA in non-traumatic cardiac arrest.

Easy Care study wants to demonstrate a correlation between intra-CPR infrared quantitative pupillometry and return of spontaneous circulation (ROSC). Neurological pupil index (NPi) will be used alone and in association with end-tidal CO2.

The high incidence rate, high Case fatality rate rate and high rate of neurological impairment of cardiac arrest pose a serious threat to the health of the whole population, and also bring a huge economic burden. In recent years, the "American Heart Association AHA Cardiopulmonary resuscitation and Cardiovascular Emergency Guide" has always emphasized the importance of "life chain" for the survival of patients with cardiac arrest. The hospital's survival chain emphasizes early warning recognition and activation of emergency response systems, immediate high-quality CPR, rapid defibrillation, advanced life support, and post arrest care. However, there is an urgent need for improvement and enhancement in all aspects of the chain of life for cardiac arrest. Millimeter wave radar can transmit radar signals that penetrate non-metallic substances such as clothing, detect the micro motion signals caused by human respiration and heartbeat, and then process the signals. By calculating the frequency or phase shift information in the radar echo, patient activity information can be obtained, achieving contactless and real-time detection of patient activity in the room. And it can achieve tracking of targets in scenarios where multiple people exist, while monitoring the physical signs of each target in real-time [7]; Our team has developed Cardiopulmonary resuscitation Quality Monitoring Index (CQI) and Cardiopulmonary resuscitation Ventilation Mode (CPRV) in the early stage, which are very helpful to monitor and improve the quality of Cardiopulmonary resuscitation; In recent years, the application of bedside echocardiography (PoCUS) in emergency has been significantly expanded. Although transthoracic echocardiography (TTE) can provide valuable diagnostic information for patients with cardiac arrest, it has important limitations in dynamic compression of Cardiopulmonary resuscitation. TEE can overcome many limitations of TTE, and the combination of the two can achieve visualization of resuscitation, Many signs of Cardiopulmonary resuscitation that had not been found before have been found. On the other hand, international guidelines recommend that the compression site of Cardiopulmonary resuscitation should be in the lower half of the sternum. However, research shows that there are great changes in the shape of the chest and the organizational structure directly below the compression site in normal people. The left ventricle is located in the lower quarter of the sternum, lower than the lower third of the sternum. When Cardiopulmonary resuscitation is carried out according to the current guidelines, only a small part of the ventricle is subjected to external compression, and for spinal deformity, obesity There is no corresponding research and recommendation for pregnant women and other special groups, and the extensive development of chest CT Iterative reconstruction provides the possibility of individualized evaluation. In addition, the COVID-19 in China has not yet been completely controlled. For patients suspected or confirmed to be infected with novel coronavirus, it is still challenging to carry out Cardiopulmonary resuscitation that may produce aerosols when wearing protective equipment. In summary, establishing a clinical decision-making system for the survival chain under the new situation and optimizing the survival chain process in the guidelines is of great significance for improving the survival rate and prognosis of patients with cardiac arrest, and is of great value for improving national health levels and reducing the economic burden on the government.

Management of cardiac arrest according to published guidelines has remained largely unchanged for a decade. Thames Valley Air Ambulance provide Critical Care Paramedic and Physician teams who respond to cardiac arrests and offer treatments beyond the scope of ambulance service clinicians. Following a review of practice and appraisal of evidence the investigators developed an additional algorithm for cases of adult medical cardiac arrest with refractory shockable rhythms. This adds to but does not replace the Advanced Life Support algorithm and includes: Delivering shocks with the LUCAS mechanical CPR device running After 5 shocks have been delivered placing new pads in the Anterior Posterior (AP) position Delivering shocks using the TVAA Tempus Pro defibrillator rather than the Ambulance Service defibrillator. This bundle was based on recommendations from ILCOR and the Resus Council (UK) Advanced Life Support manual and was launched in October 2021.

This study is intended to use a multicenter, double-blind, superior effect, placebo controlled randomized controlled clinical trial to explore the therapeutic effect of Levosimendan (within 6 hours after the recovery of spontaneous circulation) on mortality and multiple organ dysfunction such as heart and brain in patients with cardiac arrest who have recovered from active Cardiopulmonary resuscitation but have low cardiac output syndrome and coma, and the impact of 30-day mortality and neurological function after cardiac arrest.

Status epilepticus (SE) is found in 20-30% of patients in coma after cardiac arrest, is often refractory to medical therapy and is considered a negative prognostic factor. Intensity and duration of treatment of refractory and super-refractory post-anoxic SE pose the ethical dilemma between futility of treatments and, conversely, their premature suspension. A recent study by the Epilepsy Center of the San Gerardo Hospital has shown that patients with super-refractory post-anoxic SE and favorable prognostic indicators can achieve a good functional outcome in more than 40% of cases, if treated with intensive and protracted therapy. However, there is profound uncertainty about the best combination of antiseizure medications and anesthetics to use in this condition. A combined anti-glutamatergic therapy with ketamine (anti-NMDA receptor) and perampanel (anti-AMPA receptor), aimed at counteracting the excitotoxicity linked to global cerebral ischemia, could be particularly effective in the treatment of super-refractory SE with post-anoxic etiology. Preliminary results in the first 26 patients treated in the Coordinating Center of the project indicate that this therapy appears safe and highly effective (80% SE resolution, 40% good neurological outcome). The aim of the SUPER-CAT study is to investigate the efficacy and safety of combined therapy with ketamine and perampanel (dual anti-glutamatergic therapy) in patients with post-anoxic super-refractory status epilepticus, compared to other therapies, using a multi-centre, retrospective, cohort study design.