Abstract Details

Title Remote Ischemic Peri-Conditioning and High-dose Fentanyl as an adjunct to Targeted Temperature Management in Hypoxic ischemic Brain Injury post Cardiac Arrest (RESURRECT)

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 360

Objective To assess the role of remote ischemic peri-conditioning (RIPC) or high-dose fentanyl as an adjuvant to targeted temperature management (TTM) in preventing reperfusion injury in patients with cardiac arrest and return of spontaneous circulation (ROSC).

Background Recent trials have shown a muted effect of TTM to prevent hypoxic-ischemic brain injury. RIPC is a novel low-cost therapy which may prevent effects of acute ischemia-reperfusion injury. High-dose fentanyl has been associated with better ischemia tolerance in infants with cardiac arrest in observational studies.

Design/Methods This three-arm open-label study used block randomization with a sealed envelope system. The study was done on post-cardiac arrest patients, both male and female above the age of 18 years. All eligible patients were randomized to either TTM only or TTM+RIPC or TTM+high-dose fentanyl infusion groups. The Neuron-specific enolase (NSE) and temperature variability, were measured at 36h to 72h. The study was stopped due to low recruitment rates.

Results A total of 30 patients were screened and 12 were randomized. The mean±SD age of all the patients was 50±18.7 years, and 58.3% were males. The mean NSE at 36h was similar in all the three groups (TTM only (n=5) 57.1±25.9 ng/ml, TTM+RIC group (n=2) 77.7±0 ng/ml and TTM+High dose fentanyl group (n=5) 82.2±45.6 ng/ml; p=0.7). The mean NSE at 72 h was similar in all three groups (TTM only 88.1±0 ng/ml, TTM+RIC group 194.6 ng/ml, and TTM+high dose fentanyl group 23.1±10.9 ng/ml, p=0.2). There was no difference in average temperature variability in the three groups (p= 0.9).

Conclusions It is challenging to conduct clinical trials in patients with cardiac arrest in countries with low resources due to out-of-pocket costs incurred in the treatment. Novel strategies including low-cost critical care and TTM are required to improve enrolment and outcome in this group of patients.

Authors/Disclosures
Sahonta Rajeshwar, MD, MBBS (CMC) PRESENTER	Dr. Rajeshwar has nothing to disclose.
Mahesh Kate, MD (Alberta Health Services)	Dr. Kate has nothing to disclose.
Himani Khatter (Christian Medical College)	Ms. Khatter has nothing to disclose.
Jeyaraj D. Pandian, MD, DM (Christian Medical College)	Dr. Pandian has nothing to disclose.

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