Mean Arterial Pressure After Out-of-hospital Cardiac Arrest: the METAPHORE Randomized Trial

Status: Recruiting
Location: See all (27) locations...
Intervention Type: Procedure
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

Out-of-hospital cardiac arrest is a public health problem for which overall survival is below 10%. Post-cardiac arrest syndrome is the principal cause of death in intensive care units (ICU), due to refractory shock or brain injuries secondary to anoxia. Brain anoxia is responsible for severe neurological sequelae that may be aggravated by cerebral hypoperfusion during the first few hours after the return of spontaneous circulation. Current recommendations are to ensure that arterial blood pressure is sufficient for the perfusion of organs, but no minimum threshold mean arterial pressure (MAP) has been defined. In practice, most teams target a MAP of at least 65 mmHg. Several observational studies have shown a correlation between MAP and neurological prognosis, patients with a higher initial MAP having a better outcome. Recent pilot studies have demonstrated the feasibility of increasing the target MAP after cardiac arrest, but conflicting results have been obtained concerning patient prognosis. These findings may be explained by changes to the autoregulation of the brain after cardiac arrest, with a shift of the curve towards the right, or its abolition. Cerebral blood flow is dependent on MAP, and a target MAP of 65 mmHg for these patients may result in insufficient brain perfusion. Conversely, a too high MAP might cause brain lesions due to vasogenic edema, hemorrhagic complications or excess perfusion in conditions of diminished brain metabolism. An interventional study is required to evaluate the effect of increasing MAP on neurofunctional outcome after cardiac arrest. Given the data available for brain autoregulation, the correlation between MAP and prognosis, and the risks theoretically associated with a higher MAP, investigator plans to compare a standard threshold of MAP (≥ 65 mmHg) with a high threshold of MAP (≥ 90 mmHg). Investigator hypothesizes that a high MAP within the first 24 hours after cardiac arrest will improve neurofunctional outcome.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Admission to ICU following an out-of-hospital cardiac arrest with an initially shockable or non-shockable rhythm ;

• Sustained ROSC defined as 20 minutes with signs of circulation without the need for chest compressions;

• Under invasive mechanical ventilation for coma, defined as a Glasgow score ≤ 8/15;

• Consent from a relative or of a procedure for emergency inclusion.

Locations
Other Locations
France
CHU Brest - Hôpital de La Cavale Blanche
RECRUITING
Brest
CH Brive
RECRUITING
Brive-la-gaillarde
CHU Caen
RECRUITING
Caen
CH Cholet
RECRUITING
Cholet
CH Dieppe
RECRUITING
Dieppe
CHU Dijon - Hôpital F. Mitterrand
RECRUITING
Dijon
CHD Vendée
RECRUITING
La Roche-sur-yon
CH Versailles
NOT_YET_RECRUITING
Le Chesnay
Centre Hospitalier Du Mans
RECRUITING
Le Mans
CH Dr Schaffner
RECRUITING
Lens
CHU Lille
RECRUITING
Lille
CHU Limoges
RECRUITING
Limoges
APHM - Hôpital de la Timone
RECRUITING
Marseille
Hôpital Jacques Cartier
NOT_YET_RECRUITING
Massy
CHU Nantes
NOT_YET_RECRUITING
Nantes
CHU Nice - Hôpital Archet
RECRUITING
Nice
CHU Nice - Hôpital Pasteur
RECRUITING
Nice
CHU Nîmes
RECRUITING
Nîmes
CHR Orléans
NOT_YET_RECRUITING
Orléans
APHP - Hôpital Européen Georges Pompidou (HEGP)
RECRUITING
Paris
Hôpital Cochin
NOT_YET_RECRUITING
Paris
CHU Poitiers
RECRUITING
Poitiers
CHU Rennes
RECRUITING
Rennes
Centre Cardiologique du Nord
RECRUITING
Saint-denis
CHRU Strasbourg - Nouvel Hôpital Civil
RECRUITING
Strasbourg
CHRU Tours - Hôpital Bretonneau
RECRUITING
Tours
CH Bretagne Atlantique
RECRUITING
Vannes
Contact Information
Primary
Christelle JADEAU
cjadeau@ch-lemans.fr
+33244710781
Backup
Nicolas CHUDEAU
nchudeau@ch-lemans.fr
+33243432458
Time Frame
Start Date: 2024-09-28
Estimated Completion Date: 2028-03-28
Participants
Target number of participants: 1380
Treatments
Experimental: high MAP threshold
Norepinephrine will be titrated to maintain MAP ≥ 90 mmHg. This threshold will be maintained for the 24 hours following inclusion by the perfusion of norepinephrine at an appropriate dose.~From 24 hours after inclusion until ICU discharge, a MAP ≥ 65 mmHg will be targeted
Active_comparator: standard MAP threshold
Norepinephrine will be titrated to maintain MAP ≥ 65 mmHg. This target MAP will be maintained for 24 hours after randomization through the perfusion of norepinephrine at an appropriate flow rate.~From 24 hours after inclusion until ICU discharge, a MAP ≥ 65 mmHg will be targeted
Related Therapeutic Areas
Sponsors
Leads: Centre Hospitalier le Mans

This content was sourced from clinicaltrials.gov