Ventilation management and outcomes in out-of-hospital cardiac arrest: a protocol for a preplanned secondary analysis of the TTM2 trial

Chiara Robba, Niklas Nielsen, Josef Dankiewicz, Rafael Badenes, Denise Battaglini, Lorenzo Ball, Iole Brunetti, Wendel-Garcia Pedro David, Paul Young, Glenn Eastwood, Michelle S Chew, Janus Jakobsen, Johan Unden, Matthew Thomas, Michael Joannidis, Alistair Nichol, Andreas Lundin, Jacob Hollenberg, Gisela Lilja, Naomi E Hammond, Manoj Saxena, Annborn Martin, Miroslav Solar, Fabio Silvio Taccone, Hans A Friberg, Paolo Pelosi, Chiara Robba, Niklas Nielsen, Josef Dankiewicz, Rafael Badenes, Denise Battaglini, Lorenzo Ball, Iole Brunetti, Wendel-Garcia Pedro David, Paul Young, Glenn Eastwood, Michelle S Chew, Janus Jakobsen, Johan Unden, Matthew Thomas, Michael Joannidis, Alistair Nichol, Andreas Lundin, Jacob Hollenberg, Gisela Lilja, Naomi E Hammond, Manoj Saxena, Annborn Martin, Miroslav Solar, Fabio Silvio Taccone, Hans A Friberg, Paolo Pelosi

Abstract

Introduction: Mechanical ventilation is a fundamental component in the management of patients post cardiac arrest. However, the ventilator settings and the gas-exchange targets used after cardiac arrest may not be optimal to minimise post-anoxic secondary brain injury. Therefore, questions remain regarding the best ventilator management in such patients.

Methods and analysis: This is a preplanned analysis of the international randomised controlled trial, targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (OHCA)-target temperature management 2 (TTM2). The primary objective is to describe ventilatory settings and gas exchange in patients who required invasive mechanical ventilation and included in the TTM2 trial. Secondary objectives include evaluating the association of ventilator settings and gas-exchange values with 6 months mortality and neurological outcome. Adult patients after an OHCA who were included in the TTM2 trial and who received invasive mechanical ventilation will be eligible for this analysis. Data collected in the TTM2 trial that will be analysed include patients' prehospital characteristics, clinical examination, ventilator settings and arterial blood gases recorded at hospital and intensive care unit (ICU) admission and daily during ICU stay.

Ethics and dissemination: The TTM2 study has been approved by the regional ethics committee at Lund University and by all relevant ethics boards in participating countries. No further ethical committee approval is required for this secondary analysis. Data will be disseminated to the scientific community by abstracts and by original articles submitted to peer-reviewed journals.

Trial registration number: NCT02908308.

Keywords: adult intensive & critical care; clinical trials; respiratory physiology.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Outcome measure by mRS. mRS, Modified Rankin Scale.
Figure 2
Figure 2
Substudy and study timeline. All collected data at selected timepoints are described. ABG, arterial blood gas; BP, blood pressure; HR, heart rate; ICU, intensive care unit; MAP, mean arterial pressure; mRS, modified Rankin Scale; PEEP, positive end-expiratory pressure; Pplat, plateau pressure; ROSC, return of spontaneous circulation; RR, respiratory rate; SOFA, sequential organ failure assessment.

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Source: PubMed

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