Early Prediction of Neurological Outcome After Cardiac Arrest‐Rationale and Design of the Prospective International Observational EARLY ‐ NEURO , a STEPCARE Substudy
Year: 2026
Type: article
Study design: Study Protocol
Abstract: 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.
DOI: 10.1111/aas.70239
Authors: Marion Moseby‐Knappe, Erik Westhall, Marjolein Admiraal, Margareta Lang, Helena Levin, Johanna Hästbacka, Marjaana Tiainen, Markus Skrifvars, Gisela Lilja, Janus C. Jacobsen, Alice Lagebrant, Matt Wise, Matti Reinikainen, Paul Young, Manoj Saxena, Simon Schmidbauer, Naomi Hammond, Frances Bass, Ameldina Ceric, Caroline Kamp, Christina Sillassen, Christoph Leithner, Pascal Stammet, Matthias P. Hilty, Pedro D. Wendel‐Garcia, Georg Royl, Tobias Graf, Matt Thomas, Katie Sweet, Stepani Bendel, Joonas Tirkkonen, Annerose Mengel, Maria‐Ioanna Stefanou, Luis Georg Romundstad, Philipp Seidel, Jessica Kåhlin, Jonathan Grip, Jonna Heinonen, Rakesh H. Jadav, Jens Nee, Daniela Nowak, Matthias Hänggi, Johan Undén, Anna Lybeck, Joachim Düring, Martin Kenda, Jesper Johnsson, Niklas Nielsen, Tobias Cronberg
Institutions: Lund University, Skåne University Hospital, Helsingborgs lasarett, Tampere University Hospital, University of Helsinki, Helsinki University Hospital, University of Southern Denmark, Copenhagen University Hospital, Rigshospitalet, University Hospital of Wales, University of Eastern Finland, Kuopio University Hospital, The University of Melbourne, Wellington Hospital, Medical Research Institute of New Zealand, Monash University, UNSW Sydney, The George Institute for Global Health, St George Hospital, Royal North Shore Hospital, Northern Sydney Local Health District, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Centre Hospitalier de Luxembourg, University of Luxembourg, University of Zurich, University Hospital Zurich, Medical University of Vienna, University Hospital Schleswig-Holstein, German Centre for Cardiovascular Research, University Hospitals Bristol and Weston NHS Foundation Trust, Hertie Institute for Clinical Brain Research, University of Tübingen, National and Kapodistrian University of Athens, University General Hospital Attikon, Oslo University Hospital, Lovisenberg Diakonale Høgskole, Stavanger University Hospital, University of Stavanger, Karolinska University Hospital, Karolinska Institutet, Hallands sjukhus Halmstad, Ludwig-Maximilians-Universität München
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,430
Funders: Itä-Suomen Yliopisto, Helsingin Yliopisto, Université du Luxembourg, Medicinska Understödsföreningen Liv och Hälsa, Deutsches Zentrum für Herz-Kreislaufforschung, Universitetet i Stavanger, University of New South Wales, Monash University, Academy of Finland, Eberhard Karls Universität Tübingen, Gentofte Hospital, Universität Wien, Lunds Universitet, Hjärt-Lungfonden, Karolinska Institutet, Kuopion Yliopistollinen Sairaala, Vetenskapsrådet, Rigshospitalet, National and Kapodistrian University of Athens, Ludwig-Maximilians-Universität München, Medizinische Universität Wien, Humboldt-Universität zu Berlin, Sigrid Juséliuksen Säätiö, Syddansk Universitet, Universität Zürich, Universitätsspital Zürich, Tays, Lovisenberg Diakonale Høgskole, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Skånes universitetssjukhus, George Institute for Global Health, Health Research Council of New Zealand, Faculty of Medicine and Health, University of Sydney, Medical Research Future Fund
OpenAlex ID: W7154707676