Hypothermia After Cardiac Arrest - Effects on Myocardial Function and Inflammatory Response. (IH3)
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|ClinicalTrials.gov Identifier: NCT03743584|
Recruitment Status : Recruiting
First Posted : November 16, 2018
Last Update Posted : November 27, 2018
The on-going randomized clinical trial TTM2 (Target Hypothermia Versus Targeted Normothermia After Out-of-hospital Cardiac Arrest, NCT02908308) investigates if there is a difference in mortality, neurological function or quality of life in comatose survivors after out-of-hospital cardiac arrest if treated (Group A) at target temperature of 33 oC or (Group B) by avoiding fever during the first 24 h.
In this sub study, the effect of different target temperatures on cardiac and circulatory physiology is evaluated by echocardiography and pulmonary artery catheter. Tissue damage after cardiac arrest in part is caused by an activation of different parts of the inflammatory system (reperfusion injury). This study investigates the effect of temperature management on inflammation and the link to the circulatory effects.
|Condition or disease||Intervention/treatment||Phase|
|Out of Hospital Cardiac Arrest Inflammatory Response Ischemia Reperfusion Injury Hypothermia||Procedure: Targeted temperature management Procedure: Standard care, early treatment of fever||Not Applicable|
Hypothermia (HT) is used as an adjunctive treatment to improve outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA). Optimal temperature is debated and in the TTM-trial (Target Temperature Management study), which randomized to management at either 33 degrees C or 36 degrees C for 24h after return of spontaneous circulation (ROSC), no difference in mortality or neurological outcome was shown. The TTM-2-trial (Target Hypothermia Versus Targeted Normothermia After Out-of-hospital Cardiac Arrest, NCT02908308) was initiated to investigate if there is a difference in mortality, neurological function or quality of life between target temperature of 33 degrees C or avoiding fever in comatose patients after out-of-hospital cardiac arrest and meet some of the critique that was raised against the TTM-trial regarding the speed of induction of hypothermia, that both groups were treated at different degrees of hypothermia and that both groups could have benefitted from this intervention.
This study is a prospective sub-study to the TTM-2 trial investigating the cardiac and hemodynamic effects of different target temperatures using echocardiography and pulmonary artery catheter (PAC). Data will be harvested and echocardiographic registration will be made during the target temperature phase, upon rewarming and after 48-72 hours. There will be a follow-up echocardiographic examination at 6 months from randomization.
Ischemia/reperfusion (I/R) injury is a key challenge in myocardial infarction and cardiac arrest. In this study most patients will experience myocardial infarction affecting the heart only, while all patients will experience cardiac arrest affecting the whole body. A major determinant of long-term outcome is the degree of cell death due to stop of blood supply during ischemia and aggravation of organ damage during reperfusion caused by innate immune activation. In this study we will address the importance of the innate immune system in determining outcome and the interplay and dependency with cardiac function.
Blood samples will be collected at the same time points as echocardiography registrations and collection of hemodynamic data and analyzed post study cessation.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||50 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Triple (Participant, Investigator, Outcomes Assessor)|
|Masking Description:||The clinical team responsible for the participant (physicians, nurses and others) and involved with direct patient care will not be blinded to allocation group due to the inherent difficulty in blinding the intervention and as temperature is a vital sign required for clinical care. Measures will be taken to ensure that the information about allocation will not disseminate beyond the immediate group of caregivers responsible for patient care. A blinded physician will evaluate the patient for Cardiac function at pre-specified time-Points after randomisation and make a statement on Cardiac function.|
|Official Title:||Hypothermia After Cardiac Arrest - Effects on Myocardial Function and Inflammatory Response.|
|Actual Study Start Date :||November 8, 2018|
|Estimated Primary Completion Date :||December 31, 2020|
|Estimated Study Completion Date :||July 1, 2021|
Experimental: Targeted temperature management at 33°C
Cooling and temperature control at 33°C, according to the study protocol of the TTM2-trial
Procedure: Targeted temperature management
Target temperature management at 33°C
Active Comparator: Standard care, early treatment of fever
Standard of care and normothermia. If temperature 37,8 °C or above use of device for temperature control.
Procedure: Standard care, early treatment of fever
Standard of care with early treatment of fever
- Change in wall motion score [ Time Frame: 48 hours , 72 hours, 6 months ]Cardiac output
- Plasma concentration of inflammatory markers [ Time Frame: 48 hours , 72 hours, 6 months ]inflammatory markers to be specified (e.g. Complement system activation, pro-inflammatory cytokines like IL-6 expressed as nanogram/milliliter)
- Association between inflammatory response and cardiac function [ Time Frame: 48 hours , 72 hours, 6 months ]Association of plasma concentration of inflammatory markers (nanogram/milliliter) and Cardiac output (liter/minute)
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03743584
|Contact: Simon Jakobsson, MDfirstname.lastname@example.org|
|Contact: Andreas Espinoza, MD, PhDemail@example.com|
|Principal Investigator:||Søren Pischke, MD, PhD||Oslo University Hospital, Oslo, Norway|