Critical Illness Related Cardiac Arrest (CIRCA) (CIRCA)

Critical Illness Related Cardiac Arrest (CIRCA): an Investigation of the Incidence and Outcome of Cardiac Arrest Within Intensive Care Units in the United Kingdom

CIRCA aims to determine the incidence and outcomes of in-hospital cardiac arrest (IHCA) in UK intensive care units (ICUs) and explore associated risk factors with ICU and hospital survival and quality of survival following hospital discharge.

Study Overview

• Status: Unknown
• Conditions: Critical Illness

Detailed Description

Cardiac arrest is often categorised by location, out-of-hospital or in-hospital (IHCA), as there are important differences in population characteristics and aetiology. The National Cardiac Arrest Audit (NCAA) was established to audit resuscitation teams in response to IHCA, and collects information about patient characteristics, resuscitation processes, and patient outcomes. However, it does not audit IHCAs that are not attended by the resuscitation team.

Critically ill patients managed in ICUs are experiencing failure of one or more organs and therefore more intensive and invasive therapies are needed to support these failing organs. As a result, ICUs have higher nursing and medical staffing ratios, and monitoring is usually continuous. Moreover, the skill mix of the multidisciplinary team is geared to advanced life support. Thus, the risk of cardiac arrest occurring, the involvement (or not) of the resuscitation team, and the probability of return of spontaneous circulation are all likely to be different to other IHCAs.

Accurate data on cardiac arrests in ICU are lacking and the investigators do not know how many IHCA occur in ICU in the UK, nor is the impact of an IHCA in ICU on outcome known. In addition, it is not known if these IHCAs in ICUs represent an unavoidable consequence of critical illness or, more importantly, whether they can be predicted and/or prevented.

CIRCA is a prospective, multi-centre observational cohort study nested in the Case Mix Programme (CMP) and NCAA national clinical audits. The investigators aim to determine the incidence and outcomes of IHCA in UK ICUs and explore associated risk factors with ICU and hospital survival and quality of survival following hospital discharge.

• Study Type: Observational
• Enrollment (Anticipated): 1800

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, WC1V 6AZ
    • Recruiting
    • Intensive Care National Audit & Research Centre
    • Contact: ICNARC CTU; Phone Number: 02072699277; Email: circa@icnarc.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Adults having cardiac arrest (defined as receipt of chest compressions and/or defibrillation) after admission to an Intensive Care Unit (ICU) participating in the Case Mix Programme in a hospital participating in the National Cardiac Arrest Audit

Description

Inclusion Criteria:

1. Age 18 years old or more; and either
2. Cardiac arrest (defined as receipt of chest compressions or defibrillation) occurring while in-hospital and within intensive care (defined as either ICU, HDU or combined ICU/HDU); or
3. Family member of a patient surviving to discharge from intensive care after a cardiac arrest within ICU

Exclusion Criteria:

There are no exclusion criteria

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Critical-illness related cardiac arrest (CIRCA); Those experiencing a critical illness-related cardiac arrest in a participating adult, general ICU

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence	Incidence of critical illness related cardiac arrest	Up to 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Subsequent incidence of in-hospital cardiac arrest	Subsequent incidence of in-hospital cardiac arrest obtained through data linkage to the National Cardiac Arrest Audit	Up to 12 months
Survival status at hospital discharge	Survival status at hospital discharge obtained from data linkage to the Case Mix Programme	Up to 12 months
Survival status at 12 months	Survival status at 12 months obtained from data linkage to NHS Digital	12 months
Patient quality of life measured through EQ-5D-5L questionnaire completion at 3 months	Patient quality of life measured through completion of EuroQol 5 Dimension (5 level) questionnaire at 3 months following critical illness related cardiac arrest	3 months
Patient quality of life measured through EQ-5D-5L questionnaire completion at 6 months	Patient quality of life measured through completion of EuroQol 5 Dimension (5 level) questionnaire at 6 months following critical illness related cardiac arrest	6 months
Patient quality of life measured through EQ-5D-5L questionnaire completion at 12 months	Patient quality of life measured through completion of EuroQol 5 Dimension (5 level) questionnaire at 12 months following critical illness related cardiac arrest	12 months
Patient quality of life measured through IQCODE questionnaire completion at 3 months	Patient quality of life measured through completion of Informant Questionnaire on Cognitive Decline in the Elderly questionnaire at 3 months following critical illness related cardiac arrest	3 months
Patient quality of life measured through IQCODE questionnaire completion at 6 months	Patient quality of life measured through completion of Informant Questionnaire on Cognitive Decline in the Elderly questionnaire at 6 months following critical illness related cardiac arrest	6 months
Patient quality of life measured through IQCODE questionnaire completion at 12 months	Patient quality of life measured through completion of Informant Questionnaire on Cognitive Decline in the Elderly questionnaire at 12 months following critical illness related cardiac arrest	12 months
Family member quality of life measured through FROM-16 questionnaire completion at 3 months	Quality of life of family member of patients surviving critical illness related cardiac arrest measured through completion of Family Reported Outcome Measures 16 questionnaire at 3 months following patient arrest	3 months
Family member quality of life measured through FROM-16 questionnaire completion at 6 months	Quality of life of family member of patients surviving critical illness related cardiac arrest measured through completion of Family Reported Outcome Measures 16 questionnaire at 6 months following patient arrest	6 months
Family member quality of life measured through FROM-16 questionnaire completion at 12 months	Quality of life of family member of patients surviving critical illness related cardiac arrest measured through completion of Family Reported Outcome Measures 16 questionnaire at 12 months following patient arrest	12 months

Collaborators and Investigators

• Sponsor: Intensive Care National Audit & Research Centre
• Collaborators: North Bristol NHS Trust
• Investigators: Principal Investigator: Matt Thomas, MD, North Bristol NHS Trust

Study record dates

Study Major Dates

• Study Start (Actual): January 27, 2020
• Primary Completion (Anticipated): June 1, 2021
• Study Completion (Anticipated): July 1, 2022

Study Registration Dates

• First Submitted: November 21, 2019
• First Submitted That Met QC Criteria: January 3, 2020
• First Posted (Actual): January 7, 2020

Study Record Updates

• Last Update Posted (Actual): October 5, 2020
• Last Update Submitted That Met QC Criteria: October 1, 2020
• Last Verified: October 1, 2020

More Information

Terms related to this study

• Keywords: Critical Illness Related Cardiac Arrest
• Additional Relevant MeSH Terms: Pathologic Processes; Heart Diseases; Cardiovascular Diseases; Disease Attributes; Critical Illness; Heart Arrest
• Other Study ID Numbers: ICNARC/02/11/2019

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: An anonymised study dataset will be available from ICNARC on request to the Chief Investigator, subject to any necessary approvals

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No