Clinical Research Directory

Minimal Sedation Versus Standard Continuous Sedation After Out-of-Hospital Cardiac Arrest

Most patients resuscitated from out-of-hospital cardiac arrest (OHCA) remain comatose on hospital admission and are routinely managed with continuous sedation. Sedation facilitates temperature control, but deep and prolonged sedation is associated with longer mechanical ventilation, delirium, infections and delayed awakening. It is unknown whether minimizing sedation increases secondary hypoxic-ischemic brain injury. This single-centre, open-label, randomized non-inferiority trial will compare a minimal sedation strategy (no continuous sedation) with standard continuous sedation in 100 comatose adults after OHCA. The primary outcome is serum neuron-specific enolase (NSE) 72 hours after return of spontaneous circulation (ROSC). Secondary outcomes include in-hospital mortality, neurological outcome at discharge, duration of mechanical ventilation and length of ICU stay.

Psychoactive Drug Use and Acute Care Use After Trauma and Out-of-Hospital Cardiac Arrest

This retrospective population-based cohort study uses linked administrative healthcare data from the Local Health Authority of Bologna (Italy) to describe the use of four classes of psychoactive drugs (opioids, antiepileptics, antipsychotics, and antidepressants) after hospital discharge in two populations, adults admitted urgently for trauma and adults surviving out-of-hospital cardiac arrest, and to evaluate whether post-discharge exposure is associated with low-acuity or incomplete emergency department visits and urgent hospital readmissions within one year. Exposure is derived from outpatient dispensing records and classified as naive (started after discharge), long-term (before and after), or interrupted, and as current or not current over follow-up. Associations are estimated with marginal count regression models adjusted for demographics, illness or injury severity, and comorbidity, separately for each cohort.

Korean Cardiac Arrest Research Consortium

This study will evaluated the epidemiology and the outcomes of patients suffering out-of-hospital cardiac arrest with presumed cardiac etiology in Korea.

Direct or Subacute Coronary Angiography in Out-of-hospital Cardiac Arrest

The overall aim of this prospective, randomized study is to investigate whether acute coronary angiography (within 120 minutes) with a predefined strategy for revascularization, will improve 30-day survival in patients with out of hospital cardiac arrest with no signs of ST-elevation on ECG after Restoration of Spontaneous Circulation (ROSC). The patients will be randomized to a strategy of immediate coronary angiography within 120 minutes or to a strategy of delayed angiography that may be performed three days after the cardiac arrest.

Refractory Cardiac Arrest Treated On Field By ECMO

Out-of-hospital cardiac arrest without resumption of spontaneous circulatory activity despite advanced medical resuscitation is considered refractory. Under certain well-defined conditions, today in many cities around the world and particularly in Paris, it benefits from resuscitation called ECPR (extracorporeal cardiopulmonary resuscitation). This technique consists of the installation of an extracorporeal membrane oxygenation (ECMO) device allowing organ perfusion while waiting for a resumption of cardiac activity. Since 2011, the Paris SAMU (SAMU 75) has set up a team capable of implementing ECPR for refractory out-of-hospital cardiac arrests. This team based within the SAMU of Paris at the Necker hospital (ECMO team) composed of an emergency doctor or anesthesiologist-resuscitator, a nurse anesthetist and an ambulance driver intervenes in Paris and its nearby region at the request of medical regulation. Given the growing development of this activity, it is essential to measure its effectiveness in real-life conditions.