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Pain After Cardiac Arrest and Resuscitation (PAINCARE) (PAINCARE)

11. maj 2026 opdateret af: Joachim Düring, Region Skane

Characterizing and Quantifying Pain After Cardiac Arrest and Resuscitation: Insights From the PAINCARE Substudy of the STEPCARE Trial

The PAINCARE substudy is an observational cohort substudy nested within the international STEPCARE trial, which evaluates sedation, temperature, and mean arterial pressure strategies after out-of-hospital cardiac arrest. PAINCARE aims to describe the burden of pain during early intensive care after cardiac arrest and to evaluate associations between early pain burden and selected ICU and patient-reported outcomes. Pain is common in critically ill patients but may be difficult to assess in patients who are unconscious, sedated, mechanically ventilated, or unable to self-report. PAINCARE collects structured pain assessments during the first 168 hours after randomization using validated self-report or behavioral pain instruments and relates early pain burden to outcomes including delirium burden, ventilator-free time, ICU-free time, and follow-up pain outcomes. All analyses are observational; PAINCARE is not designed to determine whether modifying pain burden improves outcomes.

Studieoversigt

Status

Rekruttering

Betingelser

Detaljeret beskrivelse

PAINCARE is an exploratory observational substudy. The available sample size is expected to be approximately 300 participants and will be determined by PAINCARE participation, consent status, availability of PAINCARE data, and eligibility for the relevant analysis population. The primary analysis will estimate cumulative time in moderate/severe pain while alive and in the ICU from randomization through 168 hours, ICU discharge, or death, whichever occurs first. Secondary analyses will evaluate associations between early pain burden and selected ICU and patient-reported outcomes. Missingness will be reported by variable, timepoint, site, and ascertainment mode where feasible. Prespecified analysis rules distinguish missing scorable intervals from non-scorable intervals, allow deterministic imputation only for isolated missing scorable intervals meeting prespecified criteria, and use endpoint-specific analysis populations for secondary and exploratory analyses. Sensitivity analyses will assess robustness to assumptions about pain-data completeness, deterministic imputation, non-scorable intervals, pain-state thresholds, and ascertainment mode. Analyses will be primarily descriptive and associational; findings outside the primary analysis will be considered hypothesis-generating. PAINCARE includes both retrospectively and prospectively ascertained participants according to local approvals and substudy implementation.

Undersøgelsestype

Observationel

Tilmelding (Anslået)

300

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Undersøgelse Kontakt Backup

Studiesteder

  • Sverige
      • Halmstad, Sverige
        • Rekruttering
        • Dep. of Intensive Care Halmstad Lasarett
        • Kontakt:
          • Johan Undén, MD, PhD
      • Malmö, Sverige, 20205
        • Rekruttering
        • Department of Intensive Care, Skåne University Hospital
        • Kontakt:
        • Kontakt:
        • Ledende efterforsker:
          • Joachim P Düring, MD, PhD
      • Umeå, Sverige
        • Rekruttering
        • Dep. of Intensive Care, Norrlands Universitets Sjukhus
        • Kontakt:
          • Matthias Schien

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

STEPCARE participants at PAINCARE-participating sites who are included under approved PAINCARE substudy procedures and have not withdrawn consent for use of study data according to parent-trial procedures. PAINCARE participants may be included retrospectively or prospectively according to local approvals and substudy implementation.

Beskrivelse

Inclusion Criteria:

  • Out-of-hospital cardiac arrest
  • Adult, age 18 years or older
  • Spontaneous circulation without chest compressions for at least 20 minutes
  • Comatose, defined as not obeying verbal commands
  • Enrolled within 4 hours after return of spontaneous circulation

Exclusion Criteria:

  • Restrictions or limitations of care
  • On extracorporeal membrane oxygenation before randomization
  • Pregnancy
  • Previously randomized in the STEPCARE trial
  • Trauma or hemorrhage as the presumed cause of arrest
  • Suspected or confirmed intracranial hemorrhage

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Kohorter og interventioner

Gruppe / kohorte
Comatose out-of-hospital cardiac arrest patients
Adult participants in the STEPCARE trial (NCT05564754) enrolled at PAINCARE-participating sites under approved PAINCARE substudy procedures and not withdrawn from use of study data according to parent-trial procedures. PAINCARE inclusion may occur retrospectively or prospectively according to local approvals and substudy implementation.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Cumulative Time in Moderate or Severe Pain While Alive and in the ICU Through 168 Hours
Tidsramme: From randomization through 168 hours, ICU discharge, or death, whichever occurs first
Cumulative time, in hours, spent in moderate or severe pain while alive and in the ICU from randomization through 168 hours, ICU discharge, or death, whichever occurs first. Moderate or severe pain is defined as NRS >3, CPOT >2, or BPS >5. Each scheduled assessment represents the worst pain intensity since the previous assessment and is assigned to the corresponding preceding interval.
From randomization through 168 hours, ICU discharge, or death, whichever occurs first

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Proportion of Evaluable Alive-in-ICU Time Spent in Moderate or Severe Pain Through 168 Hours
Tidsramme: From randomization through 168 hours, ICU discharge, or death, whichever occurs first
Proportion of evaluable alive-in-ICU time spent in moderate or severe pain during the primary 0- to 168-hour pain-burden window. The proportion is calculated as cumulative evaluable time in moderate or severe pain divided by total evaluable alive-in-ICU time, excluding time after ICU discharge or death and excluding non-scorable and remaining missing scorable intervals.
From randomization through 168 hours, ICU discharge, or death, whichever occurs first
Delirium Burden Through 168 Hours
Tidsramme: From randomization through 168 hours
Proportion of evaluable point-prevalence delirium assessments with delirium present among assessments recorded as delirium present or absent through 168 hours. Delirium is assessed using the Confusion Assessment Method for the ICU or the Intensive Care Delirium Screening Checklist. Assessments recorded as not assessable are reported separately and do not contribute to the denominator; assessments recorded as not done are reported as missing.
From randomization through 168 hours
Hours Alive and Free of Invasive Ventilatory Support Through Day 30
Tidsramme: From randomization through day 30
Number of hours from randomization to day 30 during which the participant is alive and not receiving invasive ventilatory support. Participants who die before day 30 are assigned zero hours alive and free of invasive ventilatory support.
From randomization through day 30
ICU-Free Days Alive Through Day 30
Tidsramme: From randomization through day 30
Number of days from randomization to day 30 during which the participant is alive and discharged from the ICU. Participants who die before day 30 are assigned zero ICU-free days.
From randomization through day 30
Moderate or Severe Pain at 1 Month
Tidsramme: At 1 month
Moderate or severe pain at the 1-month follow-up assessment, defined as Numeric Rating Scale score greater than 3 for worst pain on movement during the preceding 24 hours.
At 1 month

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Moderate or Severe Pain at 6 Months
Tidsramme: At 6 months
Moderate or severe pain at the 6-month follow-up assessment, defined as Numeric Rating Scale score greater than 3 for worst pain on movement during the preceding 24 hours.
At 6 months
Health-Related Quality of Life at 6 Months
Tidsramme: At 6 months
Health-related quality of life at 6 months assessed using EQ-5D-5L. For exploratory binary analyses, clinically relevant health-related quality-of-life problems are defined as at least one EQ-5D-5L dimension scored at level 3 or higher. EQ-5D-5L dimension profiles and EQ VAS will also be summarized descriptively.
At 6 months
Mobilization During ICU Care
Tidsramme: From randomization through 168 hours
Mobilization during ICU care categorized as ICU Mobility Scale greater than 1 versus 1 or lower.
From randomization through 168 hours

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Region Skane

Efterforskere

  • Ledende efterforsker: Joachim P Düring, MD, PhD, Lunds Universitet, Institutionen för kliniska vetenskaper, Lund, Anesthesia and Intensive Care, Skåne University Hospital , Malmö, Sweden

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

15. oktober 2023

Primær færdiggørelse (Anslået)

19. maj 2026

Studieafslutning (Anslået)

31. oktober 2028

Datoer for studieregistrering

Først indsendt

27. april 2026

Først indsendt, der opfyldte QC-kriterier

27. april 2026

Først opslået (Faktiske)

4. maj 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

14. maj 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

11. maj 2026

Sidst verificeret

1. maj 2026

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • STEPCARE_PAINCARE

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

IPD-planbeskrivelse

Upon reasonable request to Principal investigator after publication of the STEPCARE and PAINCARE studies

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

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