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Unexpected cardiac arrest involves approximately 0.5 to 5% of patients admitted in Intensive Care Unit (ICU). Even if they have a technical environment conducive to prompt diagnosis and prompt treatment, patients hospitalized in ICU suffer from chronic illnesses and organ failure(s) that obscure the prognosis of cardiac arrest. Although extra cardiac arrhythmias or intra-hospital arrests are the subject of numerous publications, few studies specifically focus on unexpected cardiac arrest in ICU (none in France). The objective of our work is to produce a prospective epidemiological description of unexpected cardiac arrest in in French ICUs.
Unexpected cardiac arrest in ICU corresponds to cardiovascular arrest leading to at least one cardiopulmonary resuscitation technique (external cardiac massage and / or electric shock). They account for about 0.5 to 5% of admissions to intensive care units. Even if they benefit from a technical environment conducive to prompt diagnosis and rapid management, Resuscitated patients suffer from chronic diseases and organ failure (s) that darken the prognosis. Etiologies of unexpected cardiac arrest in ICU are rarely described in the literature. Their specificity comes from the fact that they can be related to patient's medical characteristics, but also to deleterious effects of supportive techniques in place at the time of circulatory arrest (respiratory assistance, vasopressor drugs, extracorporeal circulation ...). These same techniques may also reduce the effectiveness of cardiopulmonary resuscitation (cardiorespiratory interactions of respiratory assistance, pro-arrhythmogenic effect of vasopressor drugs, haemodynamic repercussion of extracorporeal circulation). Although cardiac arrests have been published extensively out of or in-hospital, there are few studies specifically concerning unexpected cardiac arrest in ICU (none in France). The prognosis is different: after an unexpected cardiac arrest in ICU, 50% of the patients recover a spontaneous cardiac activity but only 15% leave alive from the hospital (3 to 4% with a good functional autonomy). A prospective description of risk factors, circumstances and consequences in the medium term would identify (and prevent) risky situations and identify, among those at risk for unexpected cardiac arrest, those for whom a cardiopulmonary resuscitation is justified.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| cardiopulmonary resuscitation | Other | Basic cardiopulmonary resuscitation : external electric shock, external cardiac massage, adrenaline injection ... |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Patients With Unexpected Cardiac Arrest | Number of patients with at least one cardiac arrest in intensive care with attempted cardiopulmonary resuscitation as a proportion of total admissions. | 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Patients Per Reason for ICU Admission | Number of patients admitted to ICU with either Medical (vs surgical) reason for admission, circulatory failure, respiratory failure, cardiac arrest, cardiac surgery | 1 year |
| History, Comorbidities Before Unexpected Cardiac Arrest |
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Inclusion Criteria:
Exclusion Criteria:
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Patients admitted in intensive care unit during the study period and presenting an unexpected cardiac arrest will be included
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| Name | Affiliation | Role |
|---|---|---|
| Maxime Leloup, MD | Groupe Hospitalier de la Rochelle Ré Aunis | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CH Agen | Agen | France | ||||
| CHU Angers |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24326274 | Background | Rozen TH, Mullane S, Kaufman M, Hsiao YF, Warrillow S, Bellomo R, Jones DA. Antecedents to cardiac arrests in a teaching hospital intensive care unit. Resuscitation. 2014 Mar;85(3):411-7. doi: 10.1016/j.resuscitation.2013.11.018. Epub 2013 Dec 8. | |
| 7261642 | Background | Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981 Aug;9(8):591-7. doi: 10.1097/00003246-198108000-00008. |
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31,399 patients were admitted to intensive care unit (ICU), 24,245 were discharged alive without in-ICU cardiac arrest, 6,477 died in the ICU with no cardiopulmonary resuscitation (CPR) attempt, 677 had cardiac arrest with CPR attempt.
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| ID | Title | Description |
|---|---|---|
| FG000 | Shockable Rhythms | Patients with documented shockable rhythms during cardiac arrest |
| FG001 | Non-shockable Rhythms | Patients with documented non-shockable rhythms during cardiac arrest |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP_ICF | Yes | Yes | Yes | Study Protocol, Statistical Analysis Plan, and Informed Consent Form | Jan 11, 2016 |
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High blood pressure, Diabetes, Dyslipidemia, Tobacco, Ischemic heart disease, Heart disease from another cause, Malignancy, Alcohol, Renal disease, Respiratory disease, Cardiac arrest, Neurological disease, Liver disease |
| 1 year |
| Mc Cabe Score Before Unexpected Cardiac Arrest | 0- absence of underlying disease or non-life-threatening disease
| 1 year |
| Knaus Score Before Unexpected Cardiac Arrest | A- No activity limitation B- Moderate restriction of activity (limited professional activities) C- Major activity restriction but not total D- Major activity restriction, bedridden condition, long-term hospitalization | 1 year |
| Organ Failure Score Before Unexpected Cardiac Arrest | sequential organ failure assessment (SOFA) sub-score ≥ 3
| 1 year |
| Number of Participants With Unexpected Cardiac Arrest Etiologies | 1 year |
| Number of Patients With Resumption of Spontaneous Cardiac Activity After Cardiopulmonary Resuscitation | 1 year |
| Cerebral Performance Category Scale at Hospital Discharge | Cerebral performance category score (CPC)
| at Hospital Discharge |
| Cerebral Performance Category Scale at 6 Months | Cerebral performance category score (CPC)
| at 6 months after inclusion (unexpected cardiac arrest) |
| Number of Patients With Unexpected Cardiac Arrest, Resuscitated Despite Previous Decision Not to Resuscitate | 1 year |
| Angers |
| France |
| CH Angouleme | Angoulême | France |
| CH Angoulême | Angoulême | France |
| CH Arras | Arras | France |
| GH Carnelle Portes de l'Oise | Beaumont | France |
| CH Béthune | Béthune | France |
| CH Blois | Blois | France |
| APHP | Bobigny | France |
| CH Bourg en Bresse | Bourg-en-Bresse | France |
| CHU Brest | Brest | France |
| CHU Caen | Caen | France |
| CH Cahors | Cahors | France |
| CH Chartres | Chartres | France |
| CH Cholet | Cholet | France |
| CH Colmar | Colmar | France |
| CH Dieppe | Dieppe | France |
| CHU Dijon | Dijon | France |
| CH Sud Essonnes | Étampes | France |
| APHP | Garches | France |
| CHU Grenoble | Grenoble | France |
| CH Gueret | Guéret | France |
| CHU La Réunion | La Réunion | France |
| CHD Vendée | La Roche-sur-Yon | France |
| GH La Rochelle Ré Aunis | La Rochelle | France |
| CH Lens | Lens | France |
| GH de l'Institut Catholique de Lille | Lille | France |
| CHU Limoges | Limoges | France |
| CHU Lyon | Lyon | France |
| CH Meaux | Meaux | France |
| CH Melun | Melun | France |
| CHU Nantes | Nantes | France |
| CH Niort | Niort | France |
| CHU Nîmes | Nîmes | France |
| CHR Orleans | Orléans | France |
| APHP Cochin | Paris | France |
| APHP Saint Louis | Paris | France |
| Hôpital Paris Saint Joseph | Paris | France |
| CH Pau | Pau | France |
| CHU Poitiers | Poitiers | France |
| CH Pontoise | Pontoise | France |
| CH Cornouaille | Quimper | France |
| CH Roanne | Roanne | France |
| CHU Rouen | Rouen | France |
| CH Versailles | Versailles | France |
| 3416501 | Background | Synek VM. EEG abnormality grades and subdivisions of prognostic importance in traumatic and anoxic coma in adults. Clin Electroencephalogr. 1988 Jul;19(3):160-6. doi: 10.1177/155005948801900310. |
| 12668298 | Background | Myrianthefs P, Kalafati M, Lemonidou C, Minasidou E, Evagelopoulou P, Karatzas S, Baltopoulos G. Efficacy of CPR in a general, adult ICU. Resuscitation. 2003 Apr;57(1):43-8. doi: 10.1016/s0300-9572(02)00432-x. |
| 25091789 | Background | Lesieur O, Leloup M, Gonzalez F, Mamzer MF; EPILAT Study Group. Eligibility for organ donation following end-of-life decisions: a study performed in 43 French intensive care units. Intensive Care Med. 2014 Sep;40(9):1323-31. doi: 10.1007/s00134-014-3409-2. Epub 2014 Aug 5. |
| 23550795 | Background | Lee HK, Lee H, No JM, Jeon YT, Hwang JW, Lim YJ, Park HP. Factors influencing outcome in patients with cardiac arrest in the ICU. Acta Anaesthesiol Scand. 2013 Jul;57(6):784-92. doi: 10.1111/aas.12117. Epub 2013 Mar 31. |
| 2060338 | Background | Peterson MW, Geist LJ, Schwartz DA, Konicek S, Moseley PL. Outcome after cardiopulmonary resuscitation in a medical intensive care unit. Chest. 1991 Jul;100(1):168-74. doi: 10.1378/chest.100.1.168. |
| 16989937 | Background | Enohumah KO, Moerer O, Kirmse C, Bahr J, Neumann P, Quintel M. Outcome of cardiopulmonary resuscitation in intensive care units in a university hospital. Resuscitation. 2006 Nov;71(2):161-70. doi: 10.1016/j.resuscitation.2006.03.013. Epub 2006 Sep 20. |
| 1444691 | Background | Landry FJ, Parker JM, Phillips YY. Outcome of cardiopulmonary resuscitation in the intensive care setting. Arch Intern Med. 1992 Nov;152(11):2305-8. |
| 20413625 | Background | Tian J, Kaufman DA, Zarich S, Chan PS, Ong P, Amoateng-Adjepong Y, Manthous CA; American Heart Association National Registry for Cardiopulmonary Resuscitation Investigators. Outcomes of critically ill patients who received cardiopulmonary resuscitation. Am J Respir Crit Care Med. 2010 Aug 15;182(4):501-6. doi: 10.1164/rccm.200910-1639OC. Epub 2010 Apr 22. |
| 21844108 | Background | Kutsogiannis DJ, Bagshaw SM, Laing B, Brindley PG. Predictors of survival after cardiac or respiratory arrest in critical care units. CMAJ. 2011 Oct 4;183(14):1589-95. doi: 10.1503/cmaj.100034. Epub 2011 Aug 15. |
| 7719542 | Background | Smith DL, Kim K, Cairns BA, Fakhry SM, Meyer AA. Prospective analysis of outcome after cardiopulmonary resuscitation in critically ill surgical patients. J Am Coll Surg. 1995 Apr;180(4):394-401. |
| 9133537 | Background | Cummins RO, Chamberlain D, Hazinski MF, Nadkarni V, Kloeck W, Kramer E, Becker L, Robertson C, Koster R, Zaritsky A, Bossaert L, Ornato JP, Callanan V, Allen M, Steen P, Connolly B, Sanders A, Idris A, Cobbe S. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'. American Heart Association. Circulation. 1997 Apr 15;95(8):2213-39. doi: 10.1161/01.cir.95.8.2213. No abstract available. |
| 16129543 | Background | Langhelle A, Nolan J, Herlitz J, Castren M, Wenzel V, Soreide E, Engdahl J, Steen PA; 2003 Utstein Consensus Symposium. Recommended guidelines for reviewing, reporting, and conducting research on post-resuscitation care: the Utstein style. Resuscitation. 2005 Sep;66(3):271-83. doi: 10.1016/j.resuscitation.2005.06.005. |
| 22227081 | Background | Gershengorn HB, Li G, Kramer A, Wunsch H. Survival and functional outcomes after cardiopulmonary resuscitation in the intensive care unit. J Crit Care. 2012 Aug;27(4):421.e9-17. doi: 10.1016/j.jcrc.2011.11.001. Epub 2012 Jan 9. |
| 22281225 | Background | Skrifvars MB, Varghese B, Parr MJ. Survival and outcome prediction using the Apache III and the out-of-hospital cardiac arrest (OHCA) score in patients treated in the intensive care unit (ICU) following out-of-hospital, in-hospital or ICU cardiac arrest. Resuscitation. 2012 Jun;83(6):728-33. doi: 10.1016/j.resuscitation.2011.11.036. Epub 2012 Jan 25. |
| 25387815 | Background | Efendijev I, Raj R, Reinikainen M, Hoppu S, Skrifvars MB. Temporal trends in cardiac arrest incidence and outcome in Finnish intensive care units from 2003 to 2013. Intensive Care Med. 2014 Dec;40(12):1853-61. doi: 10.1007/s00134-014-3509-z. Epub 2014 Nov 12. |
| 8844239 | Background | Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul;22(7):707-10. doi: 10.1007/BF01709751. No abstract available. |
| 26092498 | Background | Lesieur O, Leloup M, Gonzalez F, Mamzer MF; EPILAT study group. Withholding or withdrawal of treatment under French rules: a study performed in 43 intensive care units. Ann Intensive Care. 2015 Dec;5(1):56. doi: 10.1186/s13613-015-0056-x. Epub 2015 Jun 19. |
| 32152653 | Result | Leloup M, Briatte I, Langlois A, Cariou A, Lesieur O; ACIR study group. Unexpected cardiac arrests occurring inside the ICU: outcomes of a French prospective multicenter study. Intensive Care Med. 2020 May;46(5):1005-1015. doi: 10.1007/s00134-020-05992-w. Epub 2020 Mar 9. |
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| ID | Title | Description |
|---|---|---|
| BG000 | Shockable Rhythms | Patients with documented shockable rhythms during cardiac arrest |
| BG001 | Non-shockable Rhythms | Patients with documented non-shockable rhythms during cardiac arrest |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Customized | Median | Inter-Quartile Range | years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
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| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Patients With Unexpected Cardiac Arrest | Number of patients with at least one cardiac arrest in intensive care with attempted cardiopulmonary resuscitation as a proportion of total admissions. | Screening of all inpatients in the ICU during the study period. Only in-ICU cardiac arrest with attempted CPR are included in the study | Posted | Count of Participants | Participants | 1 year |
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| Secondary | Number of Patients Per Reason for ICU Admission | Number of patients admitted to ICU with either Medical (vs surgical) reason for admission, circulatory failure, respiratory failure, cardiac arrest, cardiac surgery | Posted | Count of Participants | Participants | 1 year |
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| Secondary | History, Comorbidities Before Unexpected Cardiac Arrest | High blood pressure, Diabetes, Dyslipidemia, Tobacco, Ischemic heart disease, Heart disease from another cause, Malignancy, Alcohol, Renal disease, Respiratory disease, Cardiac arrest, Neurological disease, Liver disease | Posted | Count of Participants | Participants | 1 year |
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| Secondary | Mc Cabe Score Before Unexpected Cardiac Arrest | 0- absence of underlying disease or non-life-threatening disease
| Posted | Count of Participants | Participants | 1 year |
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| Secondary | Knaus Score Before Unexpected Cardiac Arrest | A- No activity limitation B- Moderate restriction of activity (limited professional activities) C- Major activity restriction but not total D- Major activity restriction, bedridden condition, long-term hospitalization | Posted | Count of Participants | Participants | 1 year |
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| Secondary | Organ Failure Score Before Unexpected Cardiac Arrest | sequential organ failure assessment (SOFA) sub-score ≥ 3
| Posted | Count of Participants | Participants | 1 year |
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| Secondary | Number of Participants With Unexpected Cardiac Arrest Etiologies | Posted | Count of Participants | Participants | 1 year |
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| Secondary | Number of Patients With Resumption of Spontaneous Cardiac Activity After Cardiopulmonary Resuscitation | Posted | Count of Participants | Participants | 1 year |
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| Secondary | Cerebral Performance Category Scale at Hospital Discharge | Cerebral performance category score (CPC)
| Posted | Count of Participants | Participants | at Hospital Discharge |
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| Secondary | Cerebral Performance Category Scale at 6 Months | Cerebral performance category score (CPC)
| Posted | Count of Participants | Participants | at 6 months after inclusion (unexpected cardiac arrest) |
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| Secondary | Number of Patients With Unexpected Cardiac Arrest, Resuscitated Despite Previous Decision Not to Resuscitate | Posted | Count of Participants | Participants | 1 year |
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6-month follow up
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | In-ICU Admissions | Patients admitted in 45 participating intensive care unit (ICU) over one year | 550 | 677 | 7 | 677 | 118 | 677 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Conscious with severe deficit | Nervous system disorders | MedDRA 10.0 | Systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Conscious without neurological deficit, minor or moderate deficit | Nervous system disorders | MedDRA 10.0 | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr Maxime Leloup | Groupe Hospitalier de la Rochelle Ré Aunis | +33 (0)5 46 45 66 09 | maxime.leloup@ght-atlantique17.fr |
| Jul 31, 2020 |
| Prot_SAP_ICF_000.pdf |
| ID | Term |
|---|---|
| D006323 | Heart Arrest |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D016887 | Cardiopulmonary Resuscitation |
| ID | Term |
|---|---|
| D012151 | Resuscitation |
| D004638 | Emergency Treatment |
| D013812 | Therapeutics |
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