EMERGEncy versus delayed coronary angiogram in survivors of out-of-hospital cardiac arrest with no obvious non-cardiac cause of arrest: Design of the EMERGE trial - 17/03/20

Doi : 10.1016/j.ahj.2020.01.006

Caroline Hauw-Berlemont, MD ^a, Lionel Lamhaut, MD, PhD ^b, Jean-Luc Diehl, MD ^a,^c, Christophe Andreotti, MD ^d, Olivier Varenne, MD, PhD ^e, Pierre Leroux, MD ^f, Jean-Baptiste Lascarrou, MD ^g, Patrice Guerin, MD, PhD ^h, Thomas Loeb, MD ⁱ, Eric Roupie, MD, PhD ^j, Cédric Daubin, MD ^k, Farzin Beygui, MD, PhD ^l, Aurélie Vilfaillot, MS ^m, Sophie Glippa ^m, Juliette Djadi-Prat, MD ^m, Gilles Chatellier, MD, PhD ^m, Alain Cariou, MD, PhD ⁿ, Christian Spaulding, MD, PhD ^o,^{^⁎}
for the EMERGE investigators
^a Medical Intensive Care Unit, European Hospital Georges Pompidou, Assitance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
^b Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Service d'Aide Médicale d'Urgence 75, Necker Hospital (APHP), Paris, France; INSERM U970 (team 4); Paris Cardiovascular Research Centre, Paris, France
^c INSERM UMR-S1140, Paris University, Paris, France
^d Service Mobile d'Urgence et de Réanimation – Emergency Department Cochin - Hôtel Dieu, Assistance Publique- Hôpitaux de Paris, Cochin Hospital, Paris, France
^e Interventional Cardiology, Cardiology Department, Groupe Hospitalier Cochin-Saint Vincent de Paul-Hôtel Dieu, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
^f Service d'Aide Médicale d'Urgence (SAMU) 44, University Hospital of Nantes, Nantes, France
^g Medical Intensive Care Unit, University Hospital of Nantes, Nantes, France
^h Unité d'hémodynamique, L'institut du thorax. University Hospital of Nantes, Nantes, France
ⁱ Service d'Aide Médicale d'Urgence (SAMU) 92, Hôpitaux Universitaires Paris-Saclay, Site Raymond Poincaré, Garches, France
^j Service d'Aide Médicale d'Urgence (SAMU) 14, University Hospital of Caen, Caen, France
^k Medical Intensive Care Unit, University Hospital of Caen, Caen, France
^l Cardiology Department, University Hospital of Caen, Caen, France
^m INSERM CIC1418 and Département d'Informatique, Biostatistique et Santé publique, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
ⁿ Medical Intensive Care Unit, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Centre – Université de Paris, Medical School, Paris, France
^o Cardiology Department, European Hospital Georges Pompidou, Assistance Publique- Hôpitaux de Paris, Paris Descartes University, Sudden Cardiac Death Expert Center, INSERM U 971, Paris, France

^⁎Reprint requests: Pr. Christian Spaulding, MD, PhD, Cardiology Department, European Hospital Georges Pompidou, Assistance Publique- Hôpitaux de Paris, Paris Descartes University, Sudden Cardiac Death Expert Center, INSERM U 971, Paris, 75015, France.Cardiology Department, European Hospital Georges Pompidou, Assistance Publique- Hôpitaux de Paris, Paris Descartes University, Sudden Cardiac Death Expert Center, INSERM U 971Paris75015France

Abstract

Background

In adults, the most common cause of out-of-hospital cardiac arrests (OHCA) is acute coronary artery occlusion. If an immediate coronary angiogram (CAG) is recommended for survivors presenting a ST segment elevation on the electrocardiogram (ECG) performed after resuscitation, there is still a debate regarding the best strategy in patients without ST segment elevation.

Hypothesis

Performing an immediate CAG after an OHCA without ST segment elevation on the post-resuscitation ECG and no obvious non-cardiac cause of arrest could lead to a better 180-day survival rate with no or minimal neurological sequel as compared with a delayed CAG performed 48 to 96 hours after the arrest.

Design

The EMERGE trial is a prospective national, randomized, open and parallel group trial, in which 970 survivors of OHCA will be randomized (1:1) to either immediate (as soon as possible after return of spontaneous circulation) or delayed (48 to 96 h) CAG. Participants will be OHCA patients with no ST segment elevation on the post resuscitation ECG and no obvious non-cardiac cause of arrest. The primary endpoint of the study is the 180-day survival rate with no or minimal neurological sequel corresponding to Cerebral Performance Category (CPC) 1 or 2. The secondary endpoints are: occurrence of shock during the first 48 hours, ventricular tachycardia and/or fibrillation during the first 48 hours, change in left ventricular ejection fraction between baseline and 180 days assessed by echocardiogram, neurological status evaluated by the CPC score at intensive care unit (ICU) discharge and day 90 neurological status assessed by the Glasgow Outcome Scale Extended score (GOSE) at 90 and 180 days, overall survival rate, and hospital length of stay.

Summary

The EMERGE trial is a prospective, multicenter, randomized, controlled trial that will assess the 180-day survival rate with no or minimal neurologic sequel in patients resuscitated from an OHCA without ST segment elevation and who will be managed with either immediate or delayed CAG.

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Plan

Study design and methods

Population

Randomization

Study procedure

Statistical considerations

Sample size calculation

Statistical analysis

Ethical considerations

	The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents.
	Take-home message: Design of the EMERGE study which compares an immediate versus a delayed CAG strategy for patients resuscitated after an OHCA without ST elevation and with no obvious non-cardiac cause of arrest.
	RCT# NCT02876458

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Vol 222

P. 131-138 - avril 2020 Retour au numéro

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EMERGEncy versus delayed coronary angiogram in survivors of out-of-hospital cardiac arrest with no obvious non-cardiac cause of arrest: Design of the EMERGE trial - 17/03/20

Abstract

Background

Hypothesis

Design

Summary

Plan

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