After resuscitation from Out-of-Hospital Cardiac Arrest (OHCA) patients experience Post
Cardiac Arrest Syndrome due to ischemia and reperfusion injury. It consists of systemic
inflammation, cerebral and myocardial dysfunction, and the condition that led to the arrest.
Most OHCA patients will receive critical care intubated in an Intensive Care Unit (ICU).
Despite this ~50% die; mainly due to brain injury. Several targets can be considered for
improving outcomes. To dampen systemic inflammation and optimize cerebral perfusion seem
important. Deep sedation has been required for targeted temperature management (TTM) but may
also be brain protective. After end of sedation, many patients have some cerebral dysfunction
that may facilitate delirium.
The aim of this trial is therefore to improve treatment of comatose OHCA patients by
evaluating 4 interventions in a factorial design addressing each of these targets in a
randomized clinical trial:
1. Systemic inflammation: Anti-inflammatory treatment with high dose steroids
(dexamethasone) or placebo.
2. Cerebral perfusion: Backrest elevation during sedation at 5 or 35 degrees.
3. Duration of sedation: Early wakeup call and potential extubation at ≤6 hours after
admission or later as current standard practice at 28-36 hours.
4. Delirium: Prophylactic treatment with anti-psychotic medication (olanzapine) or placebo.
The trial is designed as a phase III trial, randomizing 1000 patients at Danish cardiac
arrest centers.
The primary endpoint is 90 days all-cause mortality for the interventions targeting systemic
inflammation and cerebral perfusion, while it is days alive outside of hospital within 30
days for the interventions concerning duration of sedation and delirium.
The trial has potential to improve outcomes for comatose OHCA patients - a group with a grave
prognosis with currently only limited evidence-based treatments.