Predictive Outcome in Comatose Patients

NCT ID: NCT05321459

Last Updated: 2025-12-23

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

RECRUITING

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-11-15

Study Completion Date

2028-05-29

Brief Summary

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Evaluating the prognosis of comatose patients after cardiac arrest (CA) in the intensive care unit (ICU) remains challenging. It requires a multimodal approach combining standardized clinical examination, serum biomarkers, imaging and classically electrophysiological examinations, (among them auditive evoked potentials or AEP) but none has a sufficient sensitivity/specificity. In a preliminary study, the investigators developed an algorithm from the signal collected with AEP, and generated a probability map to visually classify the participants after the algorithm processing. Participants could be classified either with a good neurological prognosis or with bad neurological prognosis or death.

The investigators hypothesize that the "PRECOM" tool, applied blindly to a large prospective multicenter cohort of patients admitted to intensive care for coma in the aftermath of CA will predict neurological prognosis at 3 months with high sensitivity and specificity.

Detailed Description

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Evaluating the prognosis of comatose participants after cardiac arrest (CA) in the intensive care unit remains challenging. It requires a multimodal approach combining standardized clinical examination, serum biomarkers, imaging and classically electrophysiological examinations: 1 / the electroencephalogram, bad prognosis assessed when the electroencephalogram (EEG) is discontinuous, areactive, monotone,…), 2 / somesthetic evoked potentials, the absence of the N20 cortical wave has a specificity of poor prognosis of 68-100% and 3 / auditory evoked potentials (AEP), the presence of mismatchnegativity (MMN) would be of good prognosis with a specificity up to 90% but rarely performed in current practice. Routinely, these examinations are sometimes difficult to interpret in sedated participants, in an intensive care unit environment that generates numerous artefacts. Above all, all these techniques require the presence of a neurophysiology unit, with few experts available.

In a preliminary study, in collaboration with the applied mathematics laboratory of the ENS (Ecole Normale Supérieure), an algorithm was developed from the signal extracted from AEP. A probability map was generated with a software allowing to visually classify the participants after processing signal by the algorithm in a cluster of points with a high specificity into "good neurological prognosis" and "bad neurological prognosis". Neither artifacts or sedation prevented data analysis.

The investigators hypothesize that the "PRECOM" tool, applied blindly to a large prospective multicenter cohort of participants admitted to intensive care for coma in the aftermath of a caridiac arrest will predict the neurological prognosis of participants with high sensitivity and specificity. This tool, carried out during the first week of the coma, will be compared to a standardized procedure used routinely by the participating resuscitators.

Conditions

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Coma Heart Arrest Cardiopulmonary Resuscitation

Keywords

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Post cardiac arrest for comatose patients Electroencephalography Somatosensory evoked potentials Auditory evoked potentials Prognosis Algorithms Classification

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Comatose patients in intensive care unit

Patient admitted in the intensive care unit (ICU) for post cardiac arrest (CA) coma, persistent for at least 3 days after CA.

Neurological prognosis

Intervention Type OTHER

In usual practice, in intensive care unit, evaluating the neurological prognosis of comatose patients after cardiac arrest requires a multimodal approach combining standardized clinical examination, serum biomarkers, imaging and classically electrophysiological examinations (among them auditive evoked potentials or AEP).

An algorithm (PRECOM tool) which has been previously developed from the signal extracted from AEP allows to visually classify the patients after processing signal by the algorithm in a cluster of points with a high specificity into "good neurological prognosis" and "bad neurological prognosis".

The AEP signals recorded in the 1st and 2nd week of patient inclusion are to be collected by the neurophysiologist. At the end of the patient's participation in the study, these data will be encrypted, anonymized and transmitted to the mathematician to be processed by the PRECOM tool.

Interventions

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Neurological prognosis

In usual practice, in intensive care unit, evaluating the neurological prognosis of comatose patients after cardiac arrest requires a multimodal approach combining standardized clinical examination, serum biomarkers, imaging and classically electrophysiological examinations (among them auditive evoked potentials or AEP).

An algorithm (PRECOM tool) which has been previously developed from the signal extracted from AEP allows to visually classify the patients after processing signal by the algorithm in a cluster of points with a high specificity into "good neurological prognosis" and "bad neurological prognosis".

The AEP signals recorded in the 1st and 2nd week of patient inclusion are to be collected by the neurophysiologist. At the end of the patient's participation in the study, these data will be encrypted, anonymized and transmitted to the mathematician to be processed by the PRECOM tool.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age above18 years old
* Patient affiliated to a French Heath Care Insurance
* Admitted in the intensive care unit (ICU) for coma post extra- or intra-hospital cardiac arrest (CA) with shockable or non-shockable rhythm
* Persistent coma on day 3 after post CA, defined by the inability to respond to a verbal command in an appropriate manner (motor Glasgow components ≤ 3) and at the time of neurophysiological recordings (D3-D7 ± week -end).

Exclusion Criteria

* Decision to limit resuscitation therapies taken by the resuscitation team
* Inability to perform the auditory evoked potentials (AEP) (deafness, skin lesion or any condition preventing to record AEP).
* Opposition by the trusted person or by the patient once he/she wakes up
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ecole Normale Supérieure de Paris

UNKNOWN

Sponsor Role collaborator

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nathalie KUBIS, Md,PhD

Role: STUDY_DIRECTOR

APHP Lariboisière Hospital, Clinical Physiology Department

Locations

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APHP Avicenne Hospital - Réanimation médico-chirurgicale

Bobigny, , France

Site Status RECRUITING

APHP Lariboisière Hospital, Clinical Physiology Department

Paris, , France

Site Status ACTIVE_NOT_RECRUITING

APHP Laribosière Hospital - Service de Réanimation Médical et Toxicologique

Paris, , France

Site Status RECRUITING

APHP Cochin Hospital - médecine intensive-réanimation

Paris, , France

Site Status RECRUITING

APHP HEGP hospital - Réanimation médicale

Paris, , France

Site Status RECRUITING

APHP Bichat Hospital -Médecine intensive - réanimation infectieuse

Paris, , France

Site Status RECRUITING

Delafontaine Hospital - médecine intensive-réanimation

Saint-Denis, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Nathalie KUBIS, Md, PhD

Role: CONTACT

Phone: +33(0)149958324

Email: [email protected]

Romain SONNEVILLE, Md, PhD

Role: CONTACT

Phone: +33(0)140256139

Email: [email protected]

Facility Contacts

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Johanna OZIEL, Ph

Role: primary

Bruno MEGARBANE, MD, PhD

Role: primary

Sarah BENGHANEM, Ph

Role: primary

Jean-Luc DIEHL, Md,PhD

Role: primary

Marc DOMAN, Ph

Role: primary

Daniel DA SILVA, Md

Role: primary

Other Identifiers

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AOR 20045

Identifier Type: -

Identifier Source: org_study_id