Vfib by ECG or Echo During Cardiac Arrest

NCT ID: NCT04906252

Last Updated: 2025-04-02

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

Total Enrollment

813 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-09-15

Study Completion Date

2025-01-01

Brief Summary

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The goal of this study is to measure survival rates associated with patients presenting in cardiac arrest based on their electrocardiographic rhythm and their echocardiographic rhythm. Electrocardiographic rhythm is defined as the rhythm on the ECG and echocardiographic rhythm is the rhythm visualized on bedside ultrasound. Specifically, we will categorize patients based on identical rhythms and dichotomous rhythms with an interest in outcomes in the patient group where their echocardiographic and electrographic rhythms do not match. This is important as current ACLS protocols use electrocardiographic rhythms to determine therapy but limited research implies that therapeutic decisions based on echocardiographic rhythm may produce increased survival.

This study will occur during emergency department resuscitation of patients presenting in cardiac arrest. Patients presenting to the emergency department after cardiac arrest will undergo standard resuscitation based on ACLS protocols. Ultrasound imaging will be performed as soon as possible after the patient arrives and digitally recorded, as is currently the standard of care at the institute. Simultaneous recording of the ECG rhythm strip will occur as well. This will be repeated for as many pauses in CPR as is warranted.

Each site will record data based on the Utstein nomenclature including patient demographics, arrest details and survival outcomes. Ultrasound images and ECG recordings will be de-identified and submitted to a central database. Data will be uploaded into a centralized database. Statistical analysis will analyze outcomes based on echocardiographic and sonographic findings. Our aim is to measure the survival benefit of treating out of hospital cardiac arrest using echocardiographic rhythm instead of electrocardiographic rhythm.

Detailed Description

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This is a multi-center, prospective, observational trial involving sites across the United States and Canada. Patients will be enrolled through the emergency department either presenting in cardiac arrest, or going into cardiac arrest while in the emergency department after having arrested out of hospital. Advanced Cardiac Life Support (ACLS) protocols and institutional policies for resuscitation will be followed, as is the current standard of care. A patient encounter will conclude upon halting of cardiopulmonary resuscitation. Patient outcome will be evaluated by chart review or follow-up.

Programs involved in this study must have already integrated echocardiography into Cardiac Arrest clinically and have established procedures for how imaging is performed in the context of CPR. Echocardiography will not hinder or impair resuscitative efforts in any way, including halting CPR or prolonging pauses in CPR. Sonographic images will be obtained during designated pauses in chest compressions, as is routine care, during CPR for pulse checks, rhythm checks, and necessary resuscitative procedures.

Echocardiography will be performed as appropriate to obtain diagnostic information for each particular patient during resuscitative efforts. Recording of the image loops will be performed during image acquisition according to standard technology availability and clinical protocols at each site. To facilitate image acquisition, the ultrasound probe may be placed in the epigastrium or parasternal region during CPR with the heart centered in the field of view, if it will not interfere with ongoing resuscitation. Recording of the images can begin immediately upon pauses of CPR using whatever means are available at the site. Sonographic images will be obtained by competent personnel with experience in bedside cardiac ultrasound. This information will be made available to the physician taking care of the patient.

Continuous ECG tracings are displayed during cardiac arrest, and for the purpose of this study recordings of these ECG tracings will need to be digitally recorded. These digital ECG 'rhythm strips" will be matched with contemporaneous recordings of the ultrasound images of the heart.

Subject data, with identifiers removed, will be uploaded into the REDcap web-based database. Data will be obtained from initial patient encounter, patient records, and EMS records when available.

Contemporaneous digital recordings of ultrasound images and ECG rhythm strips blinded to patient identifiers will be included in a centralized database. Echocardiographic images will be reviewed and interpreted by the central coordinating site blinded to patient information. ECG images will be reviewed and interpreted by the central coordinating site blinded to patient information.

Patient cohorts will be compared for the electrical activity by ECG and the myocardial activity by echo.

Conditions

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Cardiac Arrest

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Ventricular Fibrillation

Patients presenting to the Emergency Department after out of hospital cardiac arrest demonstrating Ventricular Fibrillation (Vfib) Cardiac Arrest or Patients demonstrating Vfib during cardiac arrest.

Echocardiography

Intervention Type DIAGNOSTIC_TEST

Patients presenting in cardiac arrest will undergo echocardiography as is the standard of care at their institution

Electrocardiogram (ECG)

Intervention Type DIAGNOSTIC_TEST

Patients presenting in cardiac arrest will undergo an electrocardiogram (ECG) as is the standard of care at their institution

PEA

Patients presenting to the Emergency Department after out of hospital cardiac arrest demonstrating Pulseless Electrical Activity (PEA) Cardiac Arrest. Patients demonstrating PEA during cardiac arrest

Echocardiography

Intervention Type DIAGNOSTIC_TEST

Patients presenting in cardiac arrest will undergo echocardiography as is the standard of care at their institution

Electrocardiogram (ECG)

Intervention Type DIAGNOSTIC_TEST

Patients presenting in cardiac arrest will undergo an electrocardiogram (ECG) as is the standard of care at their institution

Asystole Cardiac Arrest

Patients presenting to the Emergency Department after out of hospital cardiac arrest demonstrating Asystolic Cardiac Arrest. Patients demonstrating Asystole during cardiac arrest

Echocardiography

Intervention Type DIAGNOSTIC_TEST

Patients presenting in cardiac arrest will undergo echocardiography as is the standard of care at their institution

Electrocardiogram (ECG)

Intervention Type DIAGNOSTIC_TEST

Patients presenting in cardiac arrest will undergo an electrocardiogram (ECG) as is the standard of care at their institution

Interventions

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Echocardiography

Patients presenting in cardiac arrest will undergo echocardiography as is the standard of care at their institution

Intervention Type DIAGNOSTIC_TEST

Electrocardiogram (ECG)

Patients presenting in cardiac arrest will undergo an electrocardiogram (ECG) as is the standard of care at their institution

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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Ultrasound

Eligibility Criteria

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Inclusion Criteria

* Patients presenting in out-of-hospital, atraumatic cardiac arrest

Exclusion Criteria

* Resuscitation ended due to end of life decisions
* Documented allergy to ultrasound gel
* Technical malfunction of ultrasound machine during imaging that prevents use Ultrasound machine unable to record images
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Temple University

OTHER

Sponsor Role collaborator

Stony Brook University

OTHER

Sponsor Role collaborator

University of Ottawa

OTHER

Sponsor Role collaborator

ChristianaCare

OTHER

Sponsor Role collaborator

Boston Medical Center

OTHER

Sponsor Role collaborator

Dartmouth College

OTHER

Sponsor Role collaborator

University of Alabama at Birmingham

OTHER

Sponsor Role collaborator

University of Rochester

OTHER

Sponsor Role collaborator

Baystate Medical Center

OTHER

Sponsor Role collaborator

Medical College of Wisconsin

OTHER

Sponsor Role collaborator

University of Pennsylvania

OTHER

Sponsor Role collaborator

Prisma Health-Midlands

OTHER

Sponsor Role collaborator

Allegheny Singer Research Institute (also known as Allegheny Health Network Research Institute)

OTHER

Sponsor Role collaborator

Staten Island University Hospital

OTHER

Sponsor Role collaborator

State University of New York - Upstate Medical University

OTHER

Sponsor Role collaborator

University of Manitoba

OTHER

Sponsor Role collaborator

Mayo Clinic

OTHER

Sponsor Role collaborator

Kaweah Delta Health Care District

OTHER

Sponsor Role collaborator

SBH Health System

OTHER

Sponsor Role collaborator

Yale University

OTHER

Sponsor Role collaborator

Johns Hopkins University

OTHER

Sponsor Role collaborator

The University of Texas at San Antonio

OTHER

Sponsor Role collaborator

Wake Forest University Health Sciences

OTHER

Sponsor Role collaborator

University of Arkansas

OTHER

Sponsor Role collaborator

Valleywise Health

OTHER

Sponsor Role collaborator

Kendall Healthcare Group, Ltd.

INDUSTRY

Sponsor Role collaborator

Truman Medical Center

OTHER

Sponsor Role collaborator

Oregon Health and Science University

OTHER

Sponsor Role collaborator

Vassar Brothers Medical Center

OTHER

Sponsor Role collaborator

Brookdale University Hospital Medical Center

OTHER

Sponsor Role collaborator

University of Kansas Medical Center

OTHER

Sponsor Role collaborator

University of Maine

OTHER

Sponsor Role collaborator

University of Colorado, Denver

OTHER

Sponsor Role collaborator

Duke University

OTHER

Sponsor Role collaborator

University at Buffalo

OTHER

Sponsor Role collaborator

North Shore University Hospital

OTHER

Sponsor Role collaborator

Hartford Hospital

OTHER

Sponsor Role collaborator

Louisiana State University Health Sciences Center in New Orleans

OTHER

Sponsor Role collaborator

University of Florida

OTHER

Sponsor Role collaborator

University of Maryland

OTHER

Sponsor Role collaborator

Sutter Medical Foundation

OTHER

Sponsor Role collaborator

Arizona School of Health Sciences

OTHER

Sponsor Role collaborator

Virginia Commonwealth University

OTHER

Sponsor Role collaborator

Romolo Gaspari

OTHER

Sponsor Role lead

Responsible Party

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Romolo Gaspari

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Romolo Gaspari, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

UMass Medical School

Locations

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Hartford Hospital

Hartford, Connecticut, United States

Site Status

Dartmouth Hitchcock Medical Center

Lebanon, New Hampshire, United States

Site Status

Stony Brook University

Stony Brook, New York, United States

Site Status

Duke University

Durham, North Carolina, United States

Site Status

Allegheny Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Univesity of Texas San Antonio

San Antonio, Texas, United States

Site Status

Countries

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United States

Other Identifiers

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H00021832

Identifier Type: -

Identifier Source: org_study_id

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