Cardiac arrest is a major public health problem, with 700 000 cases per year , and a survival ranging from 4 to 33%. The post- anoxic encephalopathy remains the most serious complication with only a third of survivors . It is due to a series of phenomena involving microcirculation disorders . Cerebral oximetry is a new technique to evaluate the microcirculatory status . To this day it is used in cardiovascular surgery at risk of cerebral hypoperfusion where desaturation of cerebral oximetry is synonymous with ischemia and microcirculatory disorders. Therapeutic hypothermia is the only treatment improves the outcome of patients after extra- hospital cardiac arrest resuscitation . Its mechanisms of action seem to change all the phenomena responsible for microcirculatory reperfusion disorders . Currently it is recommended to practice hypothermia between 32 and 34 ° C. However, a recent study suggests a superiority of hypothermia at 32 ° C rather than 34 ° C. The hypothesis of this study is that cerebral oximetry value will be different in patients subjected to two different levels of therapeutic hypothermia in the aftermath of an extra- hospital cardiac arrest. These data allow a better understanding of the mechanisms underlying the benefit of this technique.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
44
CH de Fréjus-Saint Raphael
Fréjus, France
CHU de Nice - Hôpital Saint Roch
Nice, France
Mesure of cerebral oximetry
During the first 48 hours of hospitalization, we will collect the cerebral oximetry values in the two cerebral hemispheres.
Time frame: 8 times during the first 48 hours of hospitalization
The cerebral oximetry values (average of the two hemispheres) will be compared between patients with good and poor neurological outcome.
The cerebral oximetry values (average of the two hemispheres) will be compared between patients with good and poor neurological outcome.
Time frame: 8 times during the first 48 hours of hospitalization
For each level of therapeutic hypothermia the cerebral oximetry values will be compared between patients with good and poor becoming
For each level of therapeutic hypothermia (32 or 34 ° C), the cerebral oximetry values (average of the two hemispheres) will be compared between patients with good and poor becoming according to the CPC score (CPC = 1 become good score - 2 and bad become CPC = 3-5).
Time frame: baseline, when target temperature is reached, 6 hours, 12 hours, 18 hours, 24 hours, when 37°C is reached
Outcome of patients
The outcome of patients (score 1-2 vs. CPC. 3-5 CPC) will be compared with the level of hypothermia (32 or 34 ° C)
Time frame: 6 months after hospitalization
Mesure of lactate
Lactate will be compared between patients with good (CPC 1-2) and poor (CPC 3-5) become throughout the study population
Time frame: 4 times during the first 48 hours of hospitalization
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