Effects of Sedation, TEmperature and Pressure After Cardiac Arrest and REsuscitation on Major Adverse Kidney Events (STEPCARE-MAKE) (STEPCARE-MAKE)
Effects of Sedation, TEmperature and Pressure After Cardiac Arrest and REsuscitation on Major Adverse Kidney Events (STEPCARE-MAKE): a Protocol for a Pre-planned Sub-study of a Randomized Clinical Trial
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
The main STEPCARE trial randomizes patients to three different interventions: (1) continuous deep sedation for 36 hours or minimal sedation (with extubation if feasible), (2) fever control with or without a feedback-controlled device if the temperature rises above 37.7°C, and (3) a mean arterial pressure (MAP) target of ≥65 mmHg or ≥85 mmHg.
This sub-study evaluates the effects of these three interventions on major adverse kidney events (MAKE), defined as a composite of death within 30 days, initiation of renal replacement therapy during the stay in the primary hospital, or persistent renal dysfunction, defined as a final creatinine value ≥200% of baseline at the time of discharge from the primary hospital.
Creatinine kinetics during the stay in the primary hospital and within 72 hours post-resuscitation are evaluated as secondary outcomes.
All data are collected prospectively as part of the main trial protocol, and analyses will be conducted according to a predefined statistical analysis plan.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Markus B Skrifvars, Prof
- Telefonnummer: +358 50 427 2424
- E-mail: markus.skrifvars@hus.fi
Undersøgelse Kontakt Backup
- Navn: Miikka Keski-Keturi, MD
- E-mail: miikka.keski-keturi@hus.fi
Studiesteder
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Brisbane, Australien
- Princess Alexandra Hospital
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Brisbane, Australien
- The Prince Charles Hospital
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Kingswood, Australien
- Nepean Hospital
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Liverpool, Australien
- Liverpool Hospital
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Melbourne, Australien
- Austin Hospital
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Sydney, Australien
- Royal North Shore Hospital
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Sydney, Australien
- St George Hospital
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Sydney, Australien
- The Sutherland Hospital
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Brussels, Belgien
- HUB Hôpital Erasme
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Ghent, Belgien
- Ghent University Hospital
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Lanaken, Belgien
- Ziekenhuis Oost-Limburg Hospital
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Basildon, Det Forenede Kongerige
- Essex cardiothoracic centre
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Bristol, Det Forenede Kongerige
- Bristol Royal Infirmary
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Cardiff, Det Forenede Kongerige
- Cardiff University Hospital
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Leeds, Det Forenede Kongerige
- Leeds General Infirmary
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London, Det Forenede Kongerige
- St Bartholomew's Hospital
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London, Det Forenede Kongerige
- St Georges University Hospital
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London, Det Forenede Kongerige
- Kings College Hospita
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Tallinn, Estland
- North Estonia Medical Centre
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Espoo, Finland
- Jorvi Hospital
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Helsinki, Finland, 00290
- Meilahti Hospital
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Jyväskylä, Finland
- Jyväskylä Hospital
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Kuopio, Finland
- Kuopio University Hospital
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Oulu, Finland
- Oulu University Hospital
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Genova, Italien
- San Martino Hospital Genova
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Luxembourg, Luxembourg
- Centre Hospitalier de Luxembourg
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Auckland, New Zealand
- DCCM ICU
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Auckland, New Zealand
- Middlemore ICU
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Auckland, New Zealand
- North Shore ICU NZ
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Christchurch, New Zealand
- Christchurch Hospital
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Wellington, New Zealand
- Wellington Hospital
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Arendal, Norge
- Soerlandet Hospital Arendal
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Grålum, Norge
- Kalnes Hospital
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Oslo, Norge
- Oslo University Hospital
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Stavanger, Norge
- Stavanger University Hospital
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Riyadh, Saudi Arabien
- King Abdulaziz Medical City
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Bern, Schweiz
- Bern University Hospital
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Sankt Gallen, Schweiz
- St Gallen Hospital
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Zurich, Schweiz
- University Hospital Zurich
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Singapore, Singapore
- Tan Tock Seng Hospital
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Gothenburg, Sverige
- Sahlgrenska University Hospital
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Halmstad, Sverige
- Hallands hospital
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Helsingborg, Sverige
- Helsingborg Hospital
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Karlstad, Sverige
- Karlstad Hospital
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Lund, Sverige
- Skane University Hospital
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Malmö, Sverige
- Skåne University Hospital Malmö
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Skövde, Sverige
- Skaraborg Hospital Skovde
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Stockholm, Sverige
- Karolinska University Hospital
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Umeå, Sverige
- University Hospital of Umeå
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Berlin, Tyskland
- Charite University Hospital
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Lübeck, Tyskland
- Lübeck University Hospital
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Tübingen, Tyskland
- Tubingen University Hospital
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- All patients included to the main STEPCARE-trial are also included to this substudy
- Out-of-hospital cardiac arrest
- Sustained return of spontaneous circulation, defined as 20 minutes with signs of circulation without the need for chest compressions
- Unconsciousness (FOUR-score motor response <4, inability to obey verbal commands), or being intubated and sedated due to agitation
- Eligible for intensive care without restrictions or limitations
- Inclusion within 4 hours of the return of spontaneous circulation
Exclusion Criteria:
- Out-of-hospital cardiac arrest of presumed traumatic or hemorrhagic origin
- Confirmed or suspected intracranial hemorrhage
- Pregnancy
- Extracorporeal membrane oxygenation (ECMO) prior to randomization
- No additional exclusion criteria are applied beyond those of the main STEPCARE trial
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Faktoriel opgave
- Maskning: Tredobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Aktiv komparator: Sedation, temperature device and high MAP
Continuous deep sedation for 36 hours, fever management with a feedback-controlled device if temperature rises above 37.7°C and a mean arterial pressure target of ≥85mmHg
|
Dyb sedation i mindst 36 timer
If core body temperature exceeds 37.7°C a feedback-controlled device will be used and set at 37.5°C
A MAP target of >85mmHg will be used.
Vasopressors will be titrated to this target during 36h
|
|
Aktiv komparator: Sedation, no temperature device and high MAP
Continuous deep sedation for 36 hours, fever management without a feedback-controlled device and a mean arterial pressure target of ≥85mmHg
|
Dyb sedation i mindst 36 timer
Håndtering af feber på intensivafdelingen uden en enhed
A MAP target of >85mmHg will be used.
Vasopressors will be titrated to this target during 36h
|
|
Aktiv komparator: Sedation, temperature device and low MAP
Continuous deep sedation for 36 hours, fever management with a feedback-controlled device if temperature rises above 37.7°C and a mean arterial pressure target of ≥65mmHg
|
Dyb sedation i mindst 36 timer
If core body temperature exceeds 37.7°C a feedback-controlled device will be used and set at 37.5°C
A MAP target of >65mmHg will be used.
Vasopressors will be titrated to this target during 36h
|
|
Aktiv komparator: Sedation, no temperature device and low MAP
Continuous deep sedation for 36 hours, fever management without a feedback-controlled device and a mean arterial pressure target of ≥65mmHg
|
Dyb sedation i mindst 36 timer
Håndtering af feber på intensivafdelingen uden en enhed
A MAP target of >65mmHg will be used.
Vasopressors will be titrated to this target during 36h
|
|
Aktiv komparator: Minimal sedation, temperature device and high MAP
Minimal sedation (and early extubation if possible), fever management with a feedback-controlled device if temperature rises above 37.7°C and a mean arterial pressure target of ≥85mmHg
|
If core body temperature exceeds 37.7°C a feedback-controlled device will be used and set at 37.5°C
A MAP target of >85mmHg will be used.
Vasopressors will be titrated to this target during 36h
A strategy of minimal sedation in the ICU, sedation used only as needed to facilitate transport, imaging and invasive procedures
|
|
Aktiv komparator: Minimal sedation, no temperature device and high MAP
Minimal sedation (and early extubation if possible), fever management without a feedback-controlled device and a mean arterial pressure target of ≥65mmHg
|
Håndtering af feber på intensivafdelingen uden en enhed
A MAP target of >85mmHg will be used.
Vasopressors will be titrated to this target during 36h
A strategy of minimal sedation in the ICU, sedation used only as needed to facilitate transport, imaging and invasive procedures
|
|
Aktiv komparator: Minimal sedation, temperature device and low MAP
Minimal sedation (and early extubation if possible), fever management with a feedback-controlled device if temperature rises above 37.7°C and a mean arterial pressure target of ≥65mmHg
|
If core body temperature exceeds 37.7°C a feedback-controlled device will be used and set at 37.5°C
A MAP target of >65mmHg will be used.
Vasopressors will be titrated to this target during 36h
A strategy of minimal sedation in the ICU, sedation used only as needed to facilitate transport, imaging and invasive procedures
|
|
Aktiv komparator: Minimal sedation, no temperature device and low MAP
Minimal sedation (and early extubation if possible), fever management without a feedback-controlled device and a mean arterial pressure target of ≥65mmHg
|
Håndtering af feber på intensivafdelingen uden en enhed
A MAP target of >65mmHg will be used.
Vasopressors will be titrated to this target during 36h
A strategy of minimal sedation in the ICU, sedation used only as needed to facilitate transport, imaging and invasive procedures
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Major adverse kidney event (MAKE)
Tidsramme: 30 days
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A composite endpoint of MAKE: death from any cause by day 30, initiation of RRT during the stay in the primary hospital or persistent renal dysfunction defined as final creatinine value ≥200 % of the baseline (the highest outpatient creatinine in the previous six months, or if unavailable, the creatinine on admission) at the time of discharge from the primary hospital
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30 days
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Difference between baseline and the highest in-hospital creatinine
Tidsramme: During the stay in the index hospital following cardiac arrest, until discharge or transfer to another hospital, and within 30 days
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Difference between baseline (the highest outpatient creatinine in the previous six months, or if unavailable, the creatinine on admission) and the highest in-hospital creatinine
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During the stay in the index hospital following cardiac arrest, until discharge or transfer to another hospital, and within 30 days
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Difference between baseline and the last measured in-hospital creatinine
Tidsramme: At the time of discharge or transfer to another hospital from the index hospital following cardiac arrest, and within 30 days
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Difference between baseline (the highest outpatient creatinine in the previous six months, or if unavailable, the creatinine on admission) and the last measured in-hospital creatinine (in the primary hospital)
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At the time of discharge or transfer to another hospital from the index hospital following cardiac arrest, and within 30 days
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Difference between baseline and 72-hour creatinine
Tidsramme: 72 hours
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Difference between baseline (the highest outpatient creatinine in the previous six months, or if unavailable, the creatinine on admission) and 72-hour creatinine
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72 hours
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Difference between baseline and the highest creatinine within 72 hours
Tidsramme: 72 hours
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Difference between baseline (the highest outpatient creatinine in the previous six months, or if unavailable, the creatinine on admission) and the highest creatinine within 72 hours
|
72 hours
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Urogenitale sygdomme
- Hjerte-kar-sygdomme
- Mandlige urogenitale sygdomme
- Nyresygdomme
- Urologiske sygdomme
- Urogenitale sygdomme hos kvinder
- Kvinders urogenitale sygdomme og graviditetskomplikationer
- Hjertesygdomme
- Nyreinsufficiens
- Ændringer i kropstemperaturen
- Patologiske tilstande, tegn og symptomer
- Tegn og symptomer
- Akut nyreskade
- Hjertestop
- Feber
- Hjertestop uden for hospitalet
- Anæstesi og analgesi
- Deep Sedation
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- STEPCARE-MAKE
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
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