Out-of-hospital cardiac arrest (OHCA) prognosis remains poor : 7% of patients surviving without neurological impairment. 65% of patients dying after hospital admission were neurologically impaired. When treating a patient with CA, neurological outcome remains extremely difficult to predict, especially in the pre-hospital setting. Practitioners have very little objective information to help them with neuropronostication. Although an EtCO2 level of \< 10 mmHg is associated with a poor neurological prognosis, European recommendations point out that this data alone is not currently sufficient to predict a patient's prognosis or to make a decision to stop resuscitation. Current recommendations do not suggest any other objective parameter during resuscitation for neuropronostication of patients with out-of-hospital cardiac arrest. Cerebral tissue oxygen saturation (rSO2) is measured using the near infrared spectrometry (NIRS) technique. Cerebral NIRS (cNIRS) enables non-invasive measurement of changes in cerebral oximetry during the management of a cardiac arrest (CA). Various clinical studies conducted over the last ten years have demonstrated that there is a probable link between cNIRS levels during resuscitation and return of spontaneous circulation (ROSC), but a clear threshold value has not been defined. The aim of the NISOHCA study is to confirm that a 40% threshold of cNIRS in the pre-hospital setting for OHCA can specifically predict survival with good neurological outcome at D90 .
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
BASIC_SCIENCE
Masking
NONE
Enrollment
542
Continuous cerebral near-infrared spectroscopy (NIRSc) during resuscitation in a patient treated for out-of-hospital cardiac arrest (OHCA).
CH Colmar- Urgences - SAMU-SMUR
Colmar, France
CHR Metz-Thionville - Mercy hospital -Urgences - SAMU-SMUR
Metz, France
CHRU NANCY - urgences SAMUR SMUR- Central hospital
Nancy, France
CHU Reims - ugences - SAMU-SMUR
Reims, France
Hôpitaux universitaire de Strasbourg - Urgences - SAMU-SMUR
Strasbourg, France
CHR Troyes- Urgences - SAMU-SMUR
Troyes, France
Cerebral Performance Category (CPC)
Specificity of predicting a 90-D survival with a good neurological outcome with a mean c-NIRS \> 40% during Cardiopulmonary Resuscitation (CPR). Cerebral Performance Category (CPC) of 1 to 5. CPC 1: Complete recovery without neurological impairment or conscious with minor impairment. CPC 5: Deceased or brain dead.
Time frame: Day 90
Cerebral Performance Category (CPC)
Determine the probability of observing a poor neurological prognosis at 90 days if the average cerebral NIRS (NIRSc) is below 40% during resuscitation. Determine the probability of observing a good neurological prognosis at 90 days if the average cerebral NIRS (NIRSc) is greater than or equal to 40% during resuscitation. Identify the most appropriate NIRSc threshold to predict a good neurological prognosis at 90 days. Build a multi-marker model for neurological prognosis including NIRSc. Cerebral Performance Category (CPC) of 1 to 5. CPC 1: Complete recovery without neurological impairment or conscious with minor impairment. CPC 5: Deceased or brain dead.
Time frame: Day 90
Cerebral Performance Category (CPC) after Return of Spontaneous Circulation(ROSC)
Assessment of c-NIRS after Return of Spontaneous Circulation(ROSC) for patients with a good neurological outcome at 90-D. Cerebral Performance Category (CPC) of 1 to 5. CPC 1: Complete recovery without neurological impairment or conscious with minor impairment. CPC 5: Deceased or brain dead
Time frame: Day 90
Return of Spontaneous Circulation
Evaluate the association between the average Cerebral Near infrared spectroscopy (NIRSc) and the occurrence of ROSC (Return of Spontaneous Circulation).
Time frame: 1 hour
The cumulative dose of adrenaline.
Evaluate the association between the average NIRSc and the cumulative dose of adrenaline (mg/mL)
Time frame: During out-of-hospital cardiopulmonary resuscitation.
Resuscitation duration.
Evaluate the association between the average NIRSc and the duration of resuscitation (minutes).
Time frame: During out-of-hospital cardiopulmonary resuscitation.
No-flow duration
Evaluate the association between the average NIRSc and the duration of no flow (minutes)
Time frame: During out-of-hospital cardiopulmonary resuscitation.
Initial rhythm (Shockable or non-Shockable)
Evaluate the association between the average NIRSc and the inital rhythm (Shockable or non-Shockable)
Time frame: During out-of-hospital cardiopulmonary resuscitation.
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