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NCT Number: NCT07829887

Cerebral Oximetry in Management of Post Cardiac Arrest

Resuscitation from a cardiac arrest is a common reason for admission to an intensive care unit (ICU).

Because the brain is highly vulnerable to oxygen deprivation, severe brain damage often occurs during a cardiac arrest. Even when the heart has been restarted, there may continue to be reduced blood flow and oxygen delivery to the brain for many hours. ICU professionals generally do not use any tools to detect low oxygen delivery to the brain.

Most patients admitted to the ICU are initially in a coma and many will never awaken. Even if they regain consciousness, there may be long-term cognitive and functional disabilities. There are currently no specific treatments available to ICU professionals that are proven to limit brain damage and improve outcomes.

Cerebral oximetry is a non-invasive, painless, safe, and easy-to-use tool that detects reduced oxygen delivery to the brain using a sensor over the forehead. Previous research shows that reduced brain oxygen levels [(regional oxygen saturation (RSO2)] are predictive of a lower chance of awakening and having a good neurological recovery.

This study will assess treatment guided by cerebral oximetry during the initial 48 hours following cardiac arrest. Patients that are in a coma after their circulation has been restarted will be randomly allocated to either usual care based on international guidelines or a protocol aimed at maintaining RSO2 above 60% on both sides of the brain.

Cerebral oximetry will be recorded in all patients, but doctors will only be aware of it in one group. If RSO2 drops below 60% for more than 5 minutes, doctors will try to increase it. Actions taken to increase RSO2 may include raising the blood pressure by giving more intravenous fluid or using life-support drugs ("vasoconstrictors" like norepinephrine), stimulating the heart to pump more strongly with medications ("inotropes" like dobutamine, milrinone, or epinephrine), adjusting ventilator settings (to increase the amount of oxygen dissolved in blood or raise carbon dioxide levels, which increases blood flow to the brain), lowering the head of the bed (to increase blood flow to the brain), or giving a blood transfusion (only if the patient has anemia). When RSO2 has been corrected to at least 60% for more than 2 hours, doctors may reverse previous interventions. If they are unable to achieve the goal of 60%, they may lower the target. Efforts to maintain RSO2 in the target range will continue for 48 hours.

Investigators will assess how well the protocol works and whether it helps avoid critically low brain oxygen levels. Investigators will also measure various "biomarkers" in the blood that are released when the brain is damaged to see if they are lower when cerebral oximetry is used to guide treatment.

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Key information

Conditions

Post-Cardiac Arrest Syndrome Brain Diseases Brain Injuries Brain Ischemia Cardiovascular Diseases Central Nervous System Diseases Cerebrovascular Disorders Heart Arrest Heart Diseases Hypoxia Hypoxia, Brain Hypoxia-Ischemia, Brain Hypoxic-Ischemic Brain Injury Nervous System Diseases Out-of-Hospital Cardiac Arrest Pathologic Processes Pathological Conditions, Signs and Symptoms Post Cardiac Arrest Brain Injury Postoperative Complications Reperfusion Injury Signs and Symptoms Signs and Symptoms, Respiratory Vascular Diseases

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age >= 18 years
  • Cardiac arrest (in- or out-of-hospital) lasting >= 5 minutes
  • Glasgow Coma Scale score <= 8 and motor score <= 5

Exclusion criteria

  • Cardiac arrest cause was any form of brain injury
  • Cannot be enrolled within 6 hours
  • Unsupportable physiology
  • CT scan (not mandated) showing diffuse loss of grey-white differentiation

Treatment and study plan

Cerebral oximetry-guided treatment

Other

Initial goals are consistent with ILCOR guidelines. When RSO2 < 60%, treatment options include:

  • Raise MAP by 5 mmHg (recommended if MAPopt > MAPactual; maximum 85-90 mmHg).
  • Raise PCO2 by 5 mmHg (maximum 50-55 mmHg);
  • Increase PO2 to 100-150 mmHg (raise FIO2 or PEEP).
  • Increase cardiac output using fluid (if intravascular volume depletion) or inotrope (if impaired systolic function).
  • Lower head of bed (HOB) 15 degrees (consider reducing nutrition and suctioning stomach)
  • If the HB concentration < 9-10 g/dL, transfuse one unit RBCs.

MAPopt (MAP range where autoregulation best preserved) determined once daily. The order of interventions are at the discretion of the most responsible physician. Treatments should occur within 15 minutes and be separated by at least 15 minutes. If treatments ineffective or considered unsafe, target can be dropped by 5% (minimum 50%). If RSO2 stable for 2-4 hours, previous interventions can be reversed.

Primary outcomes

  1. Area under the curve (RSO2 < 60%)

    Time frame: 48 hours (2880 minutes)

    Sum of right and left forehead area under the curve (AUC), where AUC = (average reduction in RSO2 below 60% per minute) x (2880 minutes)

Secondary outcomes

  1. Area under the curve (RSO2 < 60%) in patients where initial RSO2 < 60%

    Time frame: 48 hours (2880 minutes)

    Sum of right and left forehead area under the curve (AUC), where AUC = (average reduction in RSO2 below 60% per minute) x (2880 minutes) in patients where initial RSO2 < 60%

  2. Proportion of monitoring time with RSO2 < 60%

    Time frame: Maximum of 48 hours (2880 minutes)

    (Number of minutes with RSO2 < 60%) / (Number of minutes monitored)

  3. Proportion of monitoring time with RSO2 < 60% in patients where initial RSO2 < 60%

    Time frame: Maximum of 48 hours (2880 minutes)

    (Number of minutes with RSO2 < 60%) / (Number of minutes monitored)

  4. Change in RSO2 over time in patients where baseline level < 60%

    Time frame: Initial 6 hours

    Assessed using generalized estimating equation linear models with autoregressive correlation structure

  5. Dichotomized Cerebral Performance Category (CPC)

    Time frame: 3 months

    CPC 1-2 = favourable outcome, CPC 3-5 = poor outcome

  6. 28-day mortality

    Time frame: 28 days

    Proportion dead at 28 days post-arrest

  7. Difference between baseline and day 3 biomarker levels

    Time frame: 3 days

    Baseline level measured as soon as possible following ROSC. Day 3 level measured on third morning in ICU at about 8 a.m.. Biomarkers measured will include neuron specific enolase, neurofilament light, and tau.

  8. Optic nerve sheath diameter

    Time frame: Days 1, 2, and 3 post-arrest

    Average of bilateral measurements, two planes per eye (4 total measurements)

  9. Serious Adverse Events (SAE)

    Time frame: Initial 7 days post-arrest

    Neurologic: seizures, herniation syndromes, progression to death by neurological criteria Cardiovascular: arrhythmias, development of cardiogenic shock, recurrent cardiac arrest Respiratory: ARDS, pulmonary edema Gastrointestinal: mesenteric ischemia Acute kidney injury: based on KDIGO definition

Study contacts

Contact information is provided by the study sponsor or research team.

Andreas H Kramer, MD MSc FRCPC

CONTACT

[email protected]

403-944-4749

Ish Bains, PhD

CONTACT

[email protected]

403-944-0740

Sponsors and collaborators

Lead sponsor

University of Calgary

Other

Collaborators

  • Canadian Intensive Care Foundation

Registry information

Official study title

Cerebral Oximetry in Management of Post Cardiac Arrest (COMPACT): A Pilot Randomized Controlled Trial

Acronym: COMPACT

Important dates

Study start
2025
Primary completion
2027
Study completion
2027
First posted
Sep 21, 2026
Registry last updated
Sep 21, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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