Prehospital high-dose methylprednisolone in resuscitated out-of-hospital cardiac arrest patients (STEROHCA): a randomized clinical trial
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Prehospital high-dose methylprednisolone in resuscitated out-of-hospital cardiac arrest patients (STEROHCA) : a randomized clinical trial. / Obling, Laust E.R.; Beske, Rasmus P.; Meyer, Martin A.S.; Grand, Johannes; Wiberg, Sebastian; Nyholm, Benjamin; Josiassen, Jakob; Søndergaard, Frederik T.; Mohr, Thomas; Damm-Hejmdal, Anders; Bjerre, Mette; Frikke-Schmidt, Ruth; Folke, Fredrik; Møller, Jacob E.; Kjaergaard, Jesper; Hassager, Christian.
In: Intensive Care Medicine, Vol. 49, No. 12, 2023, p. 1467-1478.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Prehospital high-dose methylprednisolone in resuscitated out-of-hospital cardiac arrest patients (STEROHCA)
T2 - a randomized clinical trial
AU - Obling, Laust E.R.
AU - Beske, Rasmus P.
AU - Meyer, Martin A.S.
AU - Grand, Johannes
AU - Wiberg, Sebastian
AU - Nyholm, Benjamin
AU - Josiassen, Jakob
AU - Søndergaard, Frederik T.
AU - Mohr, Thomas
AU - Damm-Hejmdal, Anders
AU - Bjerre, Mette
AU - Frikke-Schmidt, Ruth
AU - Folke, Fredrik
AU - Møller, Jacob E.
AU - Kjaergaard, Jesper
AU - Hassager, Christian
N1 - Publisher Copyright: © 2023, The Author(s).
PY - 2023
Y1 - 2023
N2 - Purpose: Patients who are successfully resuscitated following out-of-hospital cardiac arrest (OHCA) are still at a high risk of neurological damage and death. Inflammation and brain injury are components of the post-cardiac arrest syndrome, and can be assessed by systemic interleukin 6 (IL-6) and neuron-specific enolase (NSE). Anti-inflammatory treatment with methylprednisolone may dampen inflammation, thereby improving outcome. This study aimed to determine if prehospital high-dose methylprednisolone could reduce IL-6 and NSE in comatose OHCA patients. Methods: The STEROHCA trial was a randomized, blinded, placebo-controlled, phase II prehospital trial performed at two cardiac arrest centers in Denmark. Resuscitated comatose patients with suspected cardiac etiology were randomly assigned 1:1 to a single intravenous injection of 250 mg methylprednisolone or placebo. The co-primary outcome was reduction of IL-6 and NSE-blood levels measured daily for 72 h from admission. The main secondary outcome was survival at 180 days follow-up. Results: We randomized 137 patients to methylprednisolone (n = 68) or placebo (n = 69). We found reduced IL-6 levels (p < 0.0001) in the intervention group, with median (interquartile range, IQR) levels at 24 h of 2.1 pg/ml (1.0; 7.1) and 30.7 pg/ml (14.2; 59) in the placebo group. We observed no difference between groups in NSE levels (p = 0.22), with levels at 48 h of 18.8 ug/L (14.4; 24.6) and 14.8 ug/L (11.2; 19.4) in the intervention and placebo group, respectively. In the intervention group, 51 (75%) patients survived and 44 (64%) in the placebo group. Conclusion: Prehospital treatment with high-dose methylprednisolone to resuscitated comatose OHCA patients, resulted in reduced IL-6 levels after 24 h, but did not reduce NSE levels.
AB - Purpose: Patients who are successfully resuscitated following out-of-hospital cardiac arrest (OHCA) are still at a high risk of neurological damage and death. Inflammation and brain injury are components of the post-cardiac arrest syndrome, and can be assessed by systemic interleukin 6 (IL-6) and neuron-specific enolase (NSE). Anti-inflammatory treatment with methylprednisolone may dampen inflammation, thereby improving outcome. This study aimed to determine if prehospital high-dose methylprednisolone could reduce IL-6 and NSE in comatose OHCA patients. Methods: The STEROHCA trial was a randomized, blinded, placebo-controlled, phase II prehospital trial performed at two cardiac arrest centers in Denmark. Resuscitated comatose patients with suspected cardiac etiology were randomly assigned 1:1 to a single intravenous injection of 250 mg methylprednisolone or placebo. The co-primary outcome was reduction of IL-6 and NSE-blood levels measured daily for 72 h from admission. The main secondary outcome was survival at 180 days follow-up. Results: We randomized 137 patients to methylprednisolone (n = 68) or placebo (n = 69). We found reduced IL-6 levels (p < 0.0001) in the intervention group, with median (interquartile range, IQR) levels at 24 h of 2.1 pg/ml (1.0; 7.1) and 30.7 pg/ml (14.2; 59) in the placebo group. We observed no difference between groups in NSE levels (p = 0.22), with levels at 48 h of 18.8 ug/L (14.4; 24.6) and 14.8 ug/L (11.2; 19.4) in the intervention and placebo group, respectively. In the intervention group, 51 (75%) patients survived and 44 (64%) in the placebo group. Conclusion: Prehospital treatment with high-dose methylprednisolone to resuscitated comatose OHCA patients, resulted in reduced IL-6 levels after 24 h, but did not reduce NSE levels.
KW - Inflammation
KW - Intensive cardiovascular care
KW - Neuroprotection
KW - Out-of-hospital cardiac arrest
KW - Post-cardiac arrest syndrome
U2 - 10.1007/s00134-023-07247-w
DO - 10.1007/s00134-023-07247-w
M3 - Journal article
C2 - 37943300
AN - SCOPUS:85176100526
VL - 49
SP - 1467
EP - 1478
JO - European Journal of Intensive Care Medicine
JF - European Journal of Intensive Care Medicine
SN - 0935-1701
IS - 12
ER -
ID: 379084342