Feasibility study of normoxic versus hyperoxic therapy after cardiac arrest
A multi-centred feasibility study investigating whether a strategy of titrated oxygen administration leads to a lower mean oxygen saturation measured by pulse oximetry at hospital admission than standard care with high concentration oxygen in adults resuscitated from out-of-hospital VF and VT cardiac arrest
Medical Research Institute of New Zealand
42 participants
Oct 13, 2012
Interventional
Conditions
Summary
In animal models, exposure to high levels of oxygen after cardiac arrest worsens neurological outcome. However, clinical data are limited, and standard care of patients after cardiac arrest includes exposure to abnormally high levels of oxygen for prolonged periods. In this RCT, 42 patients resuscitated from community cardiac arrest will receive either standard therapy with high concentration oxygen or careful titration of oxygen to avoid either abnormally high or low oxygen levels. The feasibility study will be undertaken in Auckland, Wellington, and Christchurch. This study will determine whether patients can be effectively randomised into a study with the proposed design, and whether separation of oxygen exposure between study groups can be achieved. If careful titration of oxygen is ultimately shown to reduce brain injury after cardiac arrest, this finding will have a major impact on the management of cardiac arrest in New Zealand and internationally.
Eligibility
Inclusion Criteria3
- Return of spontaneous circulation following cardiac arrest due to a primary cardiac cause with an initial rhythm of VF or VT
- Aged 16-90 years
- Ventilated via endotracheal tube or laryngeal mask airway.
Exclusion Criteria1
- Obvious pregnancy 2. Living in supported care or a nursing home 3. Terminal disease 4. More than 20 minutes have elapsed since return of spontaneous circulation
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Interventions
Patients assigned to the ‘avoidance of hyperoxia’ arm will receive titrated oxygen from the time of ROSC aiming to achieve oxygen saturation of 90-94% via pulse oximeter. If pulse oximetry cannot be established or stops working in the ambulance, patients will be administered 100% oxygen until such time as working pulse oximetry can be established to avoid any risk of severe undetected hypoxaemia. Titrated oxygen therapy via adjustments in ventilator inspired oxygen concentration will then be maintained throughout the period of treatment in the emergency department and ICU up until extubation or 72 hours post ROSC (whichever is sooner). Once patients have arrived in the hospital, oxygen can be titrated according to blood gases if pulse oximetry is not reading reliably. In these circumstances, the oxygen concentration should be titrated to the oxygen saturation on the blood gases rather than to the PaO2.
Locations(1)
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ACTRN12612001054808