Early Prediction of Neurological Outcome After Cardiac Arrest-Rationale and Design of the Prospective International Observational EARLY-NEURO, a STEPCARE Substudy. - 2026
Early Prediction of Neurological Outcome After Cardiac Arrest-Rationale and Design of the Prospective International Observational EARLY-NEURO, a STEPCARE Substudy.
[en] [en] BACKGROUND: Guidelines discourage prediction of neurological outcome in comatose patients within the first 72 h after cardiac arrest. Increasing evidence suggests that patients with the most severe brain injury and those with no or minimal brain injury may be identified before 72 h using novel methods. We present a protocol for the EARLY-NEURO study, which aims to evaluate whether good and poor outcomes can be reliably predicted already from 24 h after cardiac arrest using the most commonly available methods.
METHODS: Protocol for a prospective international multicenter substudy within the Sedation, TEmperature and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial where adults post-arrest are randomized to minimal or deep sedation, fever treatment with or without a temperature management device and to two different targets of mean arterial blood pressure. Patients sedated or still unconscious at 24 h are examined with head computed tomography (CT) and electroencephalogram (EEG). Blood samples are collected at 24 h after randomization, and stored for analysis of the brain injury marker neurofilament light. CT and EEG examinations will be centrally evaluated for signs of a likely poor or good outcome applying standardized criteria by raters blinded to treatment allocations and patient outcomes. Intensive care treatment, neurological prognostication, and criteria for withdrawal of care will be according to the STEPCARE protocol. Timepoint and reasons for withdrawal of life-sustaining therapy (WLST) will be recorded. WLST prior to 72 h after randomization based on a presumed futile neurological prognosis is strongly discouraged. Primary outcome will be good or poor functional outcome, assessed by the modified Rankin Scale (dichotomized as 0-3 versus 4-6) at 6 months. Results will be reported in accordance with the Standards for Reporting Diagnostic Accuracy (STARD).
CONCLUSIONS: Earlier prognostication aims to balance the avoidance of premature treatment withdrawal in patients with favorable potential against the prevention of unnecessary intervention in patients with a definitely poor prognosis.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Moseby-Knappe, Marion ; Department of Neurological Rehabilitation, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
Westhall, Erik; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Clinical Neurophysiology, Skåne University Hospital, Lund, Sweden
Admiraal, Marjolein; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Clinical Neurophysiology, Skåne University Hospital, Lund, Sweden
Lang, Margareta; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Radiology, Helsingborg Hospital, Helsingborg, Sweden
Levin, Helena; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Research, Development, Education and Innovation, Skåne University Hospital, Lund, Sweden
Hästbacka, Johanna; Faculty of Medicine and Health Technology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa and Tampere University, Tampere, Finland
Tiainen, Marjaana ; Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Skrifvars, Markus ; Department of Anesthesia and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Lilja, Gisela ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Neurology, Skåne University Hospital, Lund, Sweden
Jacobsen, Janus C; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark ; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Lagebrant, Alice; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Neurology, Skåne University Hospital, Malmö, Sweden
Wise, Matt; Adult Critical Care, University Hospital of Wales, Cardiff, UK
Reinikainen, Matti; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland ; Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
Young, Paul; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand ; Medical Research Institute of New Zealand, Wellington, New Zealand ; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia ; Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
Saxena, Manoj; Critical Care Division and Department of Intensive Care Medicine, the George Institute for Global Health and St George Hospital Clinical School, University of New South Wales, Sydney, Australia
Schmidbauer, Simon; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Anesthesia and Intensive Care, Skåne University Hospital, Malmö, Sweden
Hammond, Naomi; Critical Care Program, the George Institute for Global Health, UNSW Sydney, Randwick, New South Wales, Australia ; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
Bass, Frances; The George Institute for Global Health, Sydney, Australia ; Royal North Shore Hospital, Sydney, Australia
Ceric, Ameldina; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Anesthesia and Intensive Care, Skåne University Hospital, Malmö, Sweden
Kamp, Caroline ; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark ; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Sillassen, Christina ; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark ; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Leithner, Christoph; Charité-Universitätsmedizin Berlin, Department of Neurology, Freie Universität and Humboldt-Universität Zu Berlin, Berlin, Germany
STAMMET, Pascal ; University of Luxembourg > Faculty of Science, Technology and Medicine (FSTM) > Department of Health, Medicine and Life Sciences (DHML) > Medical Education ; Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
Hilty, Matthias P; Institute of Intensive Care Medicine University Hospital Zurich, Zurich, Switzerland ; Medical Faculty, University of Zurich, Zurich, Switzerland
Wendel-Garcia, Pedro D; Institute of Intensive Care Medicine University Hospital Zurich, Zurich, Switzerland ; Division of Cardiothoracic Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
Royl, Georg; Department of Neurology, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
Graf, Tobias; University Heart Center Lübeck, University Hospital Schleswig-Holstein, Schleswig-Holstein, Germany ; German Center for Cardiovascular Research (DZHK), Hamburg, Germany
Thomas, Matt; Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Sweet, Katie ; Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Bendel, Stepani ; Department of Intensive Care, Kuopio University Hospital, Kuopio, Finland
Tirkkonen, Joonas; Intensive Care Unit, Tampere University Hospital, Tampere, Finland
Mengel, Annerose; Department of Neurology and Stroke, Eberhard-Karls University of Tübingen, Tübingen, Germany ; Hertie Institute of Clinical Brain Research, University Medicine Tübingen, Germany
Stefanou, Maria-Ioanna; Department of Neurology and Stroke, University Medicine Tübingen, Germany ; Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Romundstad, Luis Georg; Department of Anesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway ; Lovisenberg Diaconal University College, Oslo, Norway
Seidel, Philipp; Department of Intensive Care Medicine, Stavanger University Hospital, Stavanger, Norway ; Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
Kåhlin, Jessica ; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden ; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
Grip, Jonathan; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden ; Department of Clintec, Karolinska Institute, Stockholm, Sweden
Heinonen, Jonna; Department of Anesthesia and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Jadav, Rakesh H; Department of Neurophysiology, University Hospital of Wales, Cardiff, UK
Nee, Jens; Department of Nephrology and Intensive Care Medicine Charité-Universitätsmedizin Berlin, Berlin, Germany
Nowak, Daniela; Institute of Intensive Care Medicine University Hospital Zurich, Zurich, Switzerland
Hänggi, Matthias ; Institute of Intensive Care Medicine University Hospital Zurich, Zurich, Switzerland
Undén, Johan; Department of Operation and Intensive Care, Hallands Hospital, Halmstad, Sweden ; Department of Anesthesia and Intensive Care, Clinical Sciences Malmö, Lund University, Lund, Sweden
Lybeck, Anna ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden
Düring, Joachim; Department of Clinical Sciences, Helsingborg, Lund University, Helsingborg, Sweden ; Department of Anesthesia and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden
Kenda, Martin; Department of Neurology, University Hospital LMU Munich, Munich, Germany
Johnsson, Jesper; Department of Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden ; Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
Nielsen, Niklas; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
Cronberg, Tobias; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Neurology, Skåne University Hospital, Lund, Sweden
Early Prediction of Neurological Outcome After Cardiac Arrest-Rationale and Design of the Prospective International Observational EARLY-NEURO, a STEPCARE Substudy.
