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  • Research protocol for platelets in out-of-hospital cardiac arrest: an observational, case-controlled, feasibility study to assess coagulation and platelet function abnormalities with ROTEM following out-of-hospital cardiac arrest (PoHCAR)

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Intensive care
Protocol
Research protocol for platelets in out-of-hospital cardiac arrest: an observational, case-controlled, feasibility study to assess coagulation and platelet function abnormalities with ROTEM following out-of-hospital cardiac arrest (PoHCAR)
  1. Agnieszka Skorko1,
  2. Matthew Thomas1,
  3. Andrew Mumford2,
  4. Thomas Johnson3,
  5. Elinor Griffiths4,
  6. Rosemary Greenwood4,
  7. Jonathan Benger5
  1. 1 Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
  2. 2 Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  3. 3 Department of Cardiology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  4. 4 Research and Innovation Office, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  5. 5 Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Agnieszka Skorko; a.skorko{at}nhs.net

Abstract

Introduction Out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 60 000 in the UK. Less than 10% of those who receive resuscitation survive to hospital discharge. For OHCA of a presumed cardiac cause, the optimal antiplatelet therapy is currently unknown. Previous studies indicate that a procoagulopathic state exists postcardiac arrest which may contribute to the formation of thrombi and contribute to poor outcomes. However, the administration of antiplatelet therapies needs to be balanced against the increased risk of bleeding that these individuals face.

Methods and analysis This observational feasibility study will recruit 30 individuals who achieve return of spontaneous circulation post-OHCA, are admitted to a single tertiary centre over a 6-month period and meet Utstein cohort criteria (witnessed cardiac arrest, VF or pulseless VT and cardiac cause of arrest likely). Rotational thromboelastometry and platelet function assessment will be performed on hospital arrival, postemergency percutaneous coronary intervention (PCI) and 12 hours, 24 hours and 48 hours post-PCI. As a comparator, 30 individuals presenting to our institution with ST-segment elevation myocardial infarction and undergoing primary PCI will have the same blood sampling performed. Plasma samples will be retained and batch tested on completion of the study for levels of protein C, protein S, thrombin–antithrombin complex, thrombin, antithrombin, plasminogen activator inhibitor-1, plasmin–antiplasmin complex, d-dimer, platelet factor-4, P selectin, E selectin and prothrombin fragments 1 and 2. 30-day follow-up for complications will be undertaken.

Ethics and dissemination This study has been approved by the Wales REC 7Research Ethics Committee. The results will be submitted to peer-reviewed medical journals and suitable national and international meetings. Results will be locally disseminated via our patient and public interest group.

Trial registration number Pre-results; ISRCTN34122839.

  • antiplatelet therapy
  • cardiac arrest
  • platelets
  • coagulation
  • thromboelastometry
  • acute coronary syndrome

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015663

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    Footnotes

    • Contributors AS, MT, RG and JB prepared the manuscript. TJ, AM and EG assisted with the study design and protocol.

    • Funding This work is supported by the Bristol CardioVascular Biomedical Research unit. Dr Skorko is funded by a National Institute for Health Research Integrated Academic Training (NIHR ACF) award in Intensive Care Medicine. Grants from the Resuscitation Council (UK) and David Telling Charitable Trust will assist with serum sample processing.

    • Competing interests None declared.

    • Ethics approval Wales REC 7 research ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement It is anticipated that anonymous data will ultimately be deposited in an appropriate data repository. Despite anonymisation of the results, the potentially sensitive nature of the data means that it will be stored under an appropriately managed access process rather than a fully ‘open data’ arrangement and access restricted to researchers who have signed a data sharing agreement and gained appropriate ethics committee approvals. The final decision regarding data access will be made in conjunction with the publishing journal.