Neuroprotective Effect of Remote Ischemic Post-conditioning in Out-of-hospital Cardiac Arrest
Trial Parameters
Brief Summary
Patients admitted to intensive care unit (ICU) following an out-of-hospital cardiac arrest (OHCA) have a high morbidity and mortality rate, primarily due to ischemia-reperfusion (I/R) syndrome leading to anoxic-ischemic brain injury. Despite current recommended advanced life support therapies, no specific treatment or procedure has yet been shown to improve the neurological outcome of such patients. Remote ischemic post-conditioning (RIPOST) which usually consists of applying brief and repeated cycles of ischemia alternating with reperfusion by inflating and deflating a blood pressure cuff or a pneumatic tourniquet placed around a limb, is a promising strategy to protect organs against I/R injury, including brain. Regarding cardiac arrest, pre-clinical studies have demonstrated an improvement in neurological outcome in animal subjects treated with RIPOST after cardiopulmonary resuscitation. The aim of our study is to demonstrate the benefit of early RIPOST in OHCA patients in reducing neurological injury and organ failure related to I/R syndrome.
Eligibility Criteria
Inclusion Criteria: * Out-of-hospital cardiac arrest with stable return of spontaneous circulation (ROSC \> 20 minutes) * Patient receiving invasive mechanical ventilation for coma (Glasgow score \< 8) * Availability of a lower limb without intravenous infusion or tension cuff positioned on it * Randomization and application of the first session of the tested procedure within 4 hours after ROSC * Consent of a next-of-kin or inclusion in emergency procedure Exclusion criteria : * Age \< 18 y.o or pregnancy * Patient unable to walk without assistance, unable to support himself properly without assistance, bedridden, incontinent and requiring nursing constant attention and care (corresponding to a mRS equal to 4 or 5) * Interval between cardiac arrest and ROSC (no flow + low flow) estimated \> 60 minutes * Unwitnessed cardiac arrest with asystole as first rhythm * In-hospital cardiac arrest * Refractory cardiac arrest (no ROSC considered as stable) * Cardiac arrest from traumatic, hemorrh