title: A pilot feasibility, safety and biological efficacy multicentre trial of therapeutic hypercapnia after cardiac arrest: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Cardiac arrest causes ischaemic brain injury. Arterial carbon dioxide tension (PaCO2) is a major determinant of cerebral blood flow. Thus, mild hypercapnia in the 24 h following cardiac arrest may increase cerebral blood flow and attenuate such injury. We describe the Carbon Control and Cardiac Arrest (CCC) trial.
  
  
  METHODS
  The CCC trial is a pilot multicentre feasibility, safety and biological efficacy randomized controlled trial recruiting adult cardiac arrest patients admitted to the intensive care unit after return of spontaneous circulation. At admission, using concealed allocation, participants are randomized to 24 h of either normocapnia (PaCO2 35 to 45 mmHg) or mild hypercapnia (PaCO2 50 to 55 mmHg). Key feasibility outcomes are recruitment rate and protocol compliance rate. The primary biological efficacy and biological safety measures are the between-groups difference in serum neuron-specific enolase and S100b protein levels at 24 h, 48 h and 72 h. Secondary outcome measure include adverse events, in-hospital mortality, and neurological assessment at 6 months.
  
  
  CONCLUSIONS
  The trial commenced in December 2012 and, when completed, will provide clinical evidence as to whether targeting mild hypercapnia for 24 h following intensive care unit admission for cardiac arrest patients is feasible and safe and whether it results in decreased concentrations of neurological injury biomarkers compared with normocapnia. Trial results will also be used to determine whether a phase IIb study powered for survival at 90 days is feasible and justified.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12612000690853 .
authors: Department of Intensive Care, Austin Hospital, Melbourne, Australia. glenn.eastwood@austin.org.au.|School of Nursing and Midwifery, Deakin University, Melbourne, Australia. glenn.eastwood@austin.org.au.|Australia New Zealand Intensive Care Society - Research Centre, Monash University, Melbourne, Australia. glenn.eastwood@austin.org.au.
authors: Glenn M
authors: GM
authors: Eastwood
authors: Department of Intensive Care Medicine and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Antoine.Schneider@chuv.ch.
authors: Antoine G
authors: AG
authors: Schneider
authors: Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan. suzuki-s@biglobe.ne.jp.
authors: Satoshi
authors: S
authors: Suzuki
authors: Australia New Zealand Intensive Care Society - Research Centre, Monash University, Melbourne, Australia. michael.bailey@monash.edu.
authors: Michael
authors: M
authors: Bailey
authors: Department of Intensive Care, Austin Hospital, Melbourne, Australia. rinaldo.bellomo@austin.org.au.|Faculty of Medicine, University of Melbourne, Melbourne, Australia. rinaldo.bellomo@austin.org.au.
authors: Rinaldo
authors: R
authors: Bellomo
mesh_terms: D000328:Adult; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002985:Clinical Protocols; D005240:Feasibility Studies; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D006935:Hypercapnia; D007362:Intensive Care Units; D011446:Prospective Studies