Critical Illness Related Cardiac Arrest (CIRCA)

Overview

CIRCA aims to determine the incidence and outcomes of in-hospital cardiac arrest (IHCA) in UK intensive care units (ICUs) and explore associated risk factors with ICU and hospital survival and quality of survival following hospital discharge.

Full Title of Study: “Critical Illness Related Cardiac Arrest (CIRCA): an Investigation of the Incidence and Outcome of Cardiac Arrest Within Intensive Care Units in the United Kingdom”

Study Type

• Study Type: Observational
• Study Design
  • Time Perspective: Prospective
• Study Primary Completion Date: June 2021

Detailed Description

Cardiac arrest is often categorised by location, out-of-hospital or in-hospital (IHCA), as there are important differences in population characteristics and aetiology. The National Cardiac Arrest Audit (NCAA) was established to audit resuscitation teams in response to IHCA, and collects information about patient characteristics, resuscitation processes, and patient outcomes. However, it does not audit IHCAs that are not attended by the resuscitation team. Critically ill patients managed in ICUs are experiencing failure of one or more organs and therefore more intensive and invasive therapies are needed to support these failing organs. As a result, ICUs have higher nursing and medical staffing ratios, and monitoring is usually continuous. Moreover, the skill mix of the multidisciplinary team is geared to advanced life support. Thus, the risk of cardiac arrest occurring, the involvement (or not) of the resuscitation team, and the probability of return of spontaneous circulation are all likely to be different to other IHCAs. Accurate data on cardiac arrests in ICU are lacking and the investigators do not know how many IHCA occur in ICU in the UK, nor is the impact of an IHCA in ICU on outcome known. In addition, it is not known if these IHCAs in ICUs represent an unavoidable consequence of critical illness or, more importantly, whether they can be predicted and/or prevented. CIRCA is a prospective, multi-centre observational cohort study nested in the Case Mix Programme (CMP) and NCAA national clinical audits. The investigators aim to determine the incidence and outcomes of IHCA in UK ICUs and explore associated risk factors with ICU and hospital survival and quality of survival following hospital discharge.

Arms, Groups and Cohorts

• Critical-illness related cardiac arrest (CIRCA)
  • Those experiencing a critical illness-related cardiac arrest in a participating adult, general ICU

Clinical Trial Outcome Measures

Primary Measures

• Incidence
  • Time Frame: Up to 12 months
  • Incidence of critical illness related cardiac arrest

Secondary Measures

• Subsequent incidence of in-hospital cardiac arrest
  • Time Frame: Up to 12 months
  • Subsequent incidence of in-hospital cardiac arrest obtained through data linkage to the National Cardiac Arrest Audit
• Survival status at hospital discharge
  • Time Frame: Up to 12 months
  • Survival status at hospital discharge obtained from data linkage to the Case Mix Programme
• Survival status at 12 months
  • Time Frame: 12 months
  • Survival status at 12 months obtained from data linkage to NHS Digital
• Patient quality of life measured through EQ-5D-5L questionnaire completion at 3 months
  • Time Frame: 3 months
  • Patient quality of life measured through completion of EuroQol 5 Dimension (5 level) questionnaire at 3 months following critical illness related cardiac arrest
• Patient quality of life measured through EQ-5D-5L questionnaire completion at 6 months
  • Time Frame: 6 months
  • Patient quality of life measured through completion of EuroQol 5 Dimension (5 level) questionnaire at 6 months following critical illness related cardiac arrest
• Patient quality of life measured through EQ-5D-5L questionnaire completion at 12 months
  • Time Frame: 12 months
  • Patient quality of life measured through completion of EuroQol 5 Dimension (5 level) questionnaire at 12 months following critical illness related cardiac arrest
• Patient quality of life measured through IQCODE questionnaire completion at 3 months
  • Time Frame: 3 months
  • Patient quality of life measured through completion of Informant Questionnaire on Cognitive Decline in the Elderly questionnaire at 3 months following critical illness related cardiac arrest
• Patient quality of life measured through IQCODE questionnaire completion at 6 months
  • Time Frame: 6 months
  • Patient quality of life measured through completion of Informant Questionnaire on Cognitive Decline in the Elderly questionnaire at 6 months following critical illness related cardiac arrest
• Patient quality of life measured through IQCODE questionnaire completion at 12 months
  • Time Frame: 12 months
  • Patient quality of life measured through completion of Informant Questionnaire on Cognitive Decline in the Elderly questionnaire at 12 months following critical illness related cardiac arrest
• Family member quality of life measured through FROM-16 questionnaire completion at 3 months
  • Time Frame: 3 months
  • Quality of life of family member of patients surviving critical illness related cardiac arrest measured through completion of Family Reported Outcome Measures 16 questionnaire at 3 months following patient arrest
• Family member quality of life measured through FROM-16 questionnaire completion at 6 months
  • Time Frame: 6 months
  • Quality of life of family member of patients surviving critical illness related cardiac arrest measured through completion of Family Reported Outcome Measures 16 questionnaire at 6 months following patient arrest
• Family member quality of life measured through FROM-16 questionnaire completion at 12 months
  • Time Frame: 12 months
  • Quality of life of family member of patients surviving critical illness related cardiac arrest measured through completion of Family Reported Outcome Measures 16 questionnaire at 12 months following patient arrest

Participating in This Clinical Trial

Inclusion Criteria

1. Age 18 years old or more; and either 2. Cardiac arrest (defined as receipt of chest compressions or defibrillation) occurring while in-hospital and within intensive care (defined as either ICU, HDU or combined ICU/HDU); or 3. Family member of a patient surviving to discharge from intensive care after a cardiac arrest within ICU Exclusion Criteria:

There are no exclusion criteria

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Investigator Details

• Lead Sponsor
  • Intensive Care National Audit & Research Centre
• Collaborator
  • North Bristol NHS Trust
• Provider of Information About this Clinical Study
  • Sponsor
• Overall Official(s)
  • Matt Thomas, MD, Principal Investigator, North Bristol NHS Trust
• Overall Contact(s)
  • Doug Gould, 02072699277, doug.gould@icnarc.org