Carbon Dioxide, Oxygen and Mean Arterial Pressure After Cardiac Arrest and Resuscitation

NCT ID: NCT02698917

Last Updated: 2018-08-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

123 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-03-22

Study Completion Date

2018-05-03

Brief Summary

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The COMACARE trial is a pilot multicenter randomized trial to assess the feasibility and effect on brain injury markers of targeting low or high normal arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2) and mean arterial pressure (MAP) in comatose, mechanically ventilated patients after out-of-hospital cardiac arrest. Using factorial design, participants are randomized at admission to intensive care unit to one of eight groups targeting either low or high normal values of PaO2, PaCO2 and MAP for 36 h. In this way, investigators will be assessing the feasibility and effect of all three variables at the same time.

The primary outcome is serum concentration of neuron-specific enolase (NSE) at 48 h after cardiac arrest. Feasibility outcome is between-group separation in PaO2, PaCO2 and MAP levels. Secondary outcomes include continuous monitoring of cerebral oxygenation, EEG and ECG for 48 h, the levels of NSE, S100B and cardiac troponin at randomization and 24, 48 and 72 h after cardiac arrest and neurological assessment at 6 months after cardiac arrest.

Detailed Description

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Conditions

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Out-of-Hospital Cardiac Arrest

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The physician determining neurological outcome at six months after cardiac arrest is blinded to the study group allocations

Study Groups

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Group 1

Low normal PaCO2, low normal PaO2, low normal MAP

Group Type ACTIVE_COMPARATOR

Low normal PaCO2

Intervention Type OTHER

4.5-4.7 kPa

Low normal PaO2

Intervention Type OTHER

10-15 kPa

Low normal MAP

Intervention Type OTHER

65-75 mmHg

Group 2

High normal PaCO2, low normal PaO2, low normal MAP

Group Type ACTIVE_COMPARATOR

High normal PaCO2

Intervention Type OTHER

5.8-6.0 kPa

Low normal PaO2

Intervention Type OTHER

10-15 kPa

Low normal MAP

Intervention Type OTHER

65-75 mmHg

Group 3

Low normal PaCO2, high normal PaO2, low normal MAP

Group Type ACTIVE_COMPARATOR

Low normal PaCO2

Intervention Type OTHER

4.5-4.7 kPa

High normal PaO2

Intervention Type OTHER

20-25 kPa

Low normal MAP

Intervention Type OTHER

65-75 mmHg

Group 4

High normal PaCO2, high normal PaO2, low normal MAP

Group Type ACTIVE_COMPARATOR

High normal PaCO2

Intervention Type OTHER

5.8-6.0 kPa

High normal PaO2

Intervention Type OTHER

20-25 kPa

Low normal MAP

Intervention Type OTHER

65-75 mmHg

Group 5

Low normal PaCO2, low normal PaO2, high normal MAP

Group Type ACTIVE_COMPARATOR

Low normal PaCO2

Intervention Type OTHER

4.5-4.7 kPa

Low normal PaO2

Intervention Type OTHER

10-15 kPa

High normal MAP

Intervention Type OTHER

80-100 mmHg

Group 6

High normal PaCO2, low normal PaO2, high normal MAP

Group Type ACTIVE_COMPARATOR

High normal PaCO2

Intervention Type OTHER

5.8-6.0 kPa

Low normal PaO2

Intervention Type OTHER

10-15 kPa

High normal MAP

Intervention Type OTHER

80-100 mmHg

Group 7

Low normal PaCO2, high normal PaO2, high normal MAP

Group Type ACTIVE_COMPARATOR

Low normal PaCO2

Intervention Type OTHER

4.5-4.7 kPa

High normal PaO2

Intervention Type OTHER

20-25 kPa

High normal MAP

Intervention Type OTHER

80-100 mmHg

Group 8

High normal PaCO2, high normal PaO2, high normal MAP

Group Type ACTIVE_COMPARATOR

High normal PaCO2

Intervention Type OTHER

5.8-6.0 kPa

High normal PaO2

Intervention Type OTHER

20-25 kPa

High normal MAP

Intervention Type OTHER

80-100 mmHg

Interventions

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Low normal PaCO2

4.5-4.7 kPa

Intervention Type OTHER

High normal PaCO2

5.8-6.0 kPa

Intervention Type OTHER

Low normal PaO2

10-15 kPa

Intervention Type OTHER

High normal PaO2

20-25 kPa

Intervention Type OTHER

Low normal MAP

65-75 mmHg

Intervention Type OTHER

High normal MAP

80-100 mmHg

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Witnessed out-of-hospital cardiac arrest with ventricular fibrillation (VF) or ventricular tachycardia (VT) as the initial rhythm
* Delay of return of spontaneous circulation (ROSC) 10-45 min from the start of the arrest
* Confirmed or suspected cardiac origin
* Mechanical ventilation
* Markedly impaired level of consciousness (no response to verbal commands and Glasgow coma scale \[GCS\] motor score \< 5)
* Deferred consent possible or likely
* Active intensive care initiated, including targeted temperature management (33-36 C)

Exclusion Criteria

* Probable withdrawal of active ICU care due to terminal illness or poor prognosis because of severely reduced functional status before cardiac arrest
* Confirmed or suspected intracranial pathology and/or suspicion of raised intracranial pressure
* Pregnancy
* Severe oxygenation problem (PaO2 / FiO2 \< 100 mmHg)
* Severe COPD
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Laerdal Foundation

OTHER

Sponsor Role collaborator

The Finnish Medical Association

OTHER

Sponsor Role collaborator

Orion Research Foundation

UNKNOWN

Sponsor Role collaborator

Finnish Society of Anaesthesiologists

UNKNOWN

Sponsor Role collaborator

Helsinki University Central Hospital

OTHER

Sponsor Role lead

Responsible Party

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Pekka Jakkula

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Matti Reinikainen, Associate Professor

Role: STUDY_DIRECTOR

Kuopio University Hospital

Locations

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Aarhus University Hospital

Aarhus, , Denmark

Site Status

Helsinki University Hospital

Helsinki, , Finland

Site Status

North Karelia Central Hospital

Joensuu, , Finland

Site Status

Central Finland Central Hospital

Jyväskylä, , Finland

Site Status

Kuopio University Hospital

Kuopio, , Finland

Site Status

Päijät-Häme Central Hospital

Lahti, , Finland

Site Status

Tampere University Hospital

Tampere, , Finland

Site Status

Countries

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Denmark Finland

References

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Laurikkala J, Ameloot K, Reinikainen M, Palmers PJ, De Deyne C, Bert F, Dupont M, Janssens S, Dens J, Hastbacka J, Jakkula P, Loisa P, Birkelund T, Wilkman E, Vaara ST, Skrifvars MB. The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials. Ann Intensive Care. 2023 Nov 21;13(1):113. doi: 10.1186/s13613-023-01210-0.

Reference Type DERIVED
PMID: 37987871 (View on PubMed)

Humaloja J, Lahde M, Ashton NJ, Reinikainen M, Hastbacka J, Jakkula P, Friberg H, Cronberg T, Pettila V, Blennow K, Zetterberg H, Skrifvars MB; COMACARE Study Groups. GFAp and tau protein as predictors of neurological outcome after out-of-hospital cardiac arrest: A post hoc analysis of the COMACARE trial. Resuscitation. 2022 Jan;170:141-149. doi: 10.1016/j.resuscitation.2021.11.033. Epub 2021 Dec 1.

Reference Type DERIVED
PMID: 34863908 (View on PubMed)

Laurikkala J, Aneman A, Peng A, Reinikainen M, Pham P, Jakkula P, Hastbacka J, Wilkman E, Loisa P, Toppila J, Birkelund T, Blennow K, Zetterberg H, Skrifvars MB. Association of deranged cerebrovascular reactivity with brain injury following cardiac arrest: a post-hoc analysis of the COMACARE trial. Crit Care. 2021 Sep 28;25(1):350. doi: 10.1186/s13054-021-03764-6.

Reference Type DERIVED
PMID: 34583763 (View on PubMed)

Ameloot K, Jakkula P, Hastbacka J, Reinikainen M, Pettila V, Loisa P, Tiainen M, Bendel S, Birkelund T, Belmans A, Palmers PJ, Bogaerts E, Lemmens R, De Deyne C, Ferdinande B, Dupont M, Janssens S, Dens J, Skrifvars MB. Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest. J Am Coll Cardiol. 2020 Aug 18;76(7):812-824. doi: 10.1016/j.jacc.2020.06.043.

Reference Type DERIVED
PMID: 32792079 (View on PubMed)

Jakkula P, Hastbacka J, Reinikainen M, Pettila V, Loisa P, Tiainen M, Wilkman E, Bendel S, Birkelund T, Pulkkinen A, Backlund M, Heino S, Karlsson S, Kopponen H, Skrifvars MB. Near-infrared spectroscopy after out-of-hospital cardiac arrest. Crit Care. 2019 May 14;23(1):171. doi: 10.1186/s13054-019-2428-3.

Reference Type DERIVED
PMID: 31088512 (View on PubMed)

Jakkula P, Reinikainen M, Hastbacka J, Loisa P, Tiainen M, Pettila V, Toppila J, Lahde M, Backlund M, Okkonen M, Bendel S, Birkelund T, Pulkkinen A, Heinonen J, Tikka T, Skrifvars MB; COMACARE study group. Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial. Intensive Care Med. 2018 Dec;44(12):2112-2121. doi: 10.1007/s00134-018-5453-9. Epub 2018 Nov 14.

Reference Type DERIVED
PMID: 30430209 (View on PubMed)

Jakkula P, Reinikainen M, Hastbacka J, Pettila V, Loisa P, Karlsson S, Laru-Sompa R, Bendel S, Oksanen T, Birkelund T, Tiainen M, Toppila J, Hakkarainen A, Skrifvars MB; COMACARE study group. Targeting low- or high-normal Carbon dioxide, Oxygen, and Mean arterial pressure After Cardiac Arrest and REsuscitation: study protocol for a randomized pilot trial. Trials. 2017 Oct 30;18(1):507. doi: 10.1186/s13063-017-2257-0.

Reference Type DERIVED
PMID: 29084585 (View on PubMed)

Other Identifiers

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15/2015

Identifier Type: -

Identifier Source: org_study_id

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