STEPCARE Trial (Clinical trials identifier:NCT05564754) includes adult out-of-hospital
cardiac arrest (OHCA) patients, with sustained ROSC, who remain comatose after
resuscitation. STEPCARE is a factorial Trial, where all participants are randomized
regarding three different interventions (minimal or deep sedation, target mean arterial
pressure 65mmHg or 85mmHg, temperature management with or without a device). Patients
with suspected or confirmed intracerebral hemorrhage, trauma or hemorrhage as reasons of
arrest, those previously randomized to STEPCARE and patients with allergy to adhesive
material or skin injury in the frontal-temporal area will be excluded (the latter two
specific to this substudy).
The investigators aim to assess whether a new, algorithm-based index derived from
continuous EEG (cEEG) recording is superior to retrospective visual analysis of cEEG in
predicting functional outcome after OHCA, assessed restrospectively from early phase
recordings, using the best hour within the 9-12-hour time interval after ROSC.
The cEEG will be collected using a commercially available Brainstatus device in selected
centers participating in the STEPCARE Trial. cEEG will be visible to clinical team in
centers using cEEG in routine monitoring, but blinded for those who do not routinely
monitor cEEG in OHCA patients. C-Trend Index is blinded to clinicians and researchers,
and will be analyzed retrospectively, after the primary outcome has been collected of the
last patient of this substudy.
The primary outcome of this substudy is the functional outcome 6 months after OHCA,
defined as modified Rankin Scale score (dichotomized as favourable mRS 0-3, and
unfavourable mRS 4-6), assessed by blinded outcome assessors.
The investigators will compare accuracy (with separate comparisons of sensitivity and
specificity) of C-Trend Index 9-12 hours after ROSC with the visual assessment of cEEG.
C-Trend Index above a predefined cut-off value 20 is defined as indicative of favorable
outcome, while in the visual assessment continuous or nearly continuous normal-voltage
background without abundant discharges is considered indicative of favorable outcome .
To demonstrate a 10% difference in the accuracy, a sample size of 271 patients is needed.
To account for loss of patients due to early wake-up, loss of follow-up, and technical
issues in recordings the investigators aim at recruiting 300 patients.
As secondary research questions the study will also assess:
The predictive accuracy off C-Trend Index in predicting unfavorable functional
outcome, compared with visual analysis of cEEG
The predictive accuracy of C-Trend Index using cut-off values 50 and 80 at 9-12
hours from ROSC in predicting favorable and unfavorable functional outcome
Whether the predictive ability or the optimal cut-off value of C-Trend Index in
predicting favorable and unfavorable functional outcome is affected by the three
different interventions of the STEPCARE study