Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Early Prediction of Neurological Outcome After Cardiac Arrest-Rationale and Design of the Prospective International Observational EARLY-NEURO, a STEPCARE Substudy

Moseby-Knappe, Marion LU ; Westhall, Erik LU ; Admiraal, Marjolein LU ; Lang, Margareta LU ; Levin, Helena LU ; Hästbacka, Johanna ; Tiainen, Marjaana ; Skrifvars, Markus ; Lilja, Gisela LU and Jacobsen, Janus C. , et al. (2026) In Acta Anaesthesiologica Scandinavica 70(5).
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... (More)

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.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
brain injury markers, cardiac arrest, CT, EEG, outcome, prognostication
in
Acta Anaesthesiologica Scandinavica
volume
70
issue
5
article number
e70239
publisher
Blackwell Munksgaard
external identifiers
  • pmid:41995094
  • scopus:105035825113
ISSN
0001-5172
DOI
10.1111/aas.70239
language
English
LU publication?
yes
id
27c67914-835c-40a8-8696-2b8aff46eed1
date added to LUP
2026-06-26 11:06:12
date last changed
2026-07-25 19:44:41
@article{27c67914-835c-40a8-8696-2b8aff46eed1,
  abstract     = {{<p>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.</p>}},
  author       = {{Moseby-Knappe, Marion and Westhall, Erik and Admiraal, Marjolein and Lang, Margareta and Levin, Helena and Hästbacka, Johanna and Tiainen, Marjaana and Skrifvars, Markus and Lilja, Gisela and Jacobsen, Janus C. and Lagebrant, Alice and Wise, Matt and Reinikainen, Matti and Young, Paul and Saxena, Manoj and Schmidbauer, Simon and Hammond, Naomi and Bass, Frances and Ceric, Ameldina and Kamp, Caroline and Sillassen, Christina and Leithner, Christoph and Stammet, Pascal and Hilty, Matthias P. and Wendel-Garcia, Pedro D. and Royl, Georg and Graf, Tobias and Thomas, Matt and Sweet, Katie and Bendel, Stepani and Tirkkonen, Joonas and Mengel, Annerose and Stefanou, Maria Ioanna and Romundstad, Luis Georg and Seidel, Philipp and Kåhlin, Jessica and Grip, Jonathan and Heinonen, Jonna and Jadav, Rakesh H. and Nee, Jens and Nowak, Daniela and Hänggi, Matthias and Undén, Johan and Lybeck, Anna and Düring, Joachim and Kenda, Martin and Johnsson, Jesper and Nielsen, Niklas and Cronberg, Tobias}},
  issn         = {{0001-5172}},
  keywords     = {{brain injury markers; cardiac arrest; CT; EEG; outcome; prognostication}},
  language     = {{eng}},
  number       = {{5}},
  publisher    = {{Blackwell Munksgaard}},
  series       = {{Acta Anaesthesiologica Scandinavica}},
  title        = {{Early Prediction of Neurological Outcome After Cardiac Arrest-Rationale and Design of the Prospective International Observational EARLY-NEURO, a STEPCARE Substudy}},
  url          = {{http://dx.doi.org/10.1111/aas.70239}},
  doi          = {{10.1111/aas.70239}},
  volume       = {{70}},
  year         = {{2026}},
}