Transorbital Ultrasound and Other Markers for Prognosis Prediction After Cardiac Arrest

N/AActive Not RecruitingNCT04838418

University Hospital Pilsen80 enrolled

Overview

In sudden cardiac arrest patients with return of spontaneous circulation, brain damage is one of the main determinants of short-term mortality and poor prognosis (CPC 3-5). It is important to properly select group of patients in whom treatment is futile. According to current guidelines, multimodal approach is recommended. Optic nerve sheath diameter measured by ultrasound is non-invasive, fast, low-cost and readily available bed-side method, but evidence for its use as neuroprognostication modality is limited to only few small studies. The aim of this study is to evaluate validity of ONSD as neuroprognostication method at larger cohort of patients, compare it with other established methods and compare ultrasound and CT measurement of ONSD.

Additional relevant MeSH terms: cardiac arrest, cardiovascular diseases, optic nerve sheath diameter.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Cardiac Arrest

Interventions

Optic nerve sheath diameter measured by transorbital ultrasoundPROCEDURE

Optic nerve sheath diameter measured 3 mm behind eyeball. For every eyeball 2 measurements in axial and 2 measurements in sagital projections are performed. Summary value for every eyeball is arithmetic mean from these 4 measurements.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * age of 18 years or older * out of hospital cardiac arrest of non-traumatic cause with CPR and subsequent ROSC * Glasgow coma scale (GCS) ≤ 7 or sedation 30 minutes after ROSC achievment Exclusion Criteria: * unavailable first measurment of the optic nerve sheath diameter (ONSD) measured by transorbital ultrasonography 24±6 hours after ROSC achievement * refractory cardiac arrest * craniocerebral injury * intracranial tumor * active intracranial bleeding * haemorrhagic stroke and/or subarachnoid haemorrhage in the last 3 months * facial trauma affecting the eye area * active neuroendocrine tumor, small cell lung cancer, non-small cell lung * CPC 3-5 before cardiac arrest * sclerosis multiplex and/or optic neuritis of other etiology

Outcomes

Primary Outcomes

Value of ONSD for short-term neurological outcome prediction

Assessment of the correlation between the optic nerve sheath diameter measured by transorbital ultrasonography and neurological outcome of patients (quantified by the CPC scale) after out of hospital cardiac arrest with subsequent ROSC

Time frame: 30 days

Value of ONSD for short-term mortality prediction

Assessment of the correlation between optic nerve sheath diameter measured by transorbital ultrasonography and mortality during a 30-day follow-up.

Time frame: 30 days

Secondary Outcomes

Comparison of ONSD and electrophysiologic modalities for neurological outcome prediction

Assessment of the correlation between the optic nerve sheath diameter measured by transorbital ultrasonography and negative prognostic markers obtained by somatosensory evoked potentials examination and EEG in patients remaining in a coma even after the end of therapeutic hypothermia and sedation.

Time frame: 96 hours

Comparison of ONSD measurements by ultrasonography and computed tomography

Assessment of accuracy of the optic nerve sheath diameter measured by ultrasonography compared to CT measurement performed 48 ± 12 hours after achievment of ROSC.

Time frame: 48 hours

Correlation between ONSD and fundoscopic signs of papillary edema

Assessment of the correlation between the optic nerve sheath diameter measured by transorbital ultrasonography and grade of optic nerve papillary edema quantified by the Frisen scale on fundoscopic examination performed 48 ± 12 hours after achievment of ROSC.

Time frame: 48 hours

Correlation between ONSD and thickness of retinal nerve fibers measured by OCT

Assessment of the correlation between the optic nerve sheath diameter measured by transorbital ultrasonography and thickness of retinal nerve fibers measured by optical coherence tomography at time intervals of 1, 3 and 5 months after achievment of ROSC.

Time frame: 5 months

Effect of blood carbon dioxide on ONSD

Assessment of the correlation between the optic nerve sheath diameter measured by transorbital ultrasonography and paCO2 and ETCO2 values at the time of measurement.

Time frame: 72 hours

Value of ONSD for long-term neurological outcome and mortality

Assessment of the correlation between the optic nerve sheath diameter measured by transorbital ultrasonography and mortality and neurological outcome of patients (quantified by the CPC scale) at 6 months after ROSC.

Time frame: 6 months

Correlation between blood NSE, copeptin and selected RNAs

Assessment of the correlation between blood NSE, copeptin and selected micro-RNAs measured at defined time intervals from ROSC, to neurological outcome prediction in patients after out of hospital cardiac arrest with subsequent ROSC.