STEROHCA
Trial question
What is the role of prehospital treatment with high-dose methylprednisolone in resuscitated comatose patients with out-of-hospital cardiac arrest?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
18.0% female
82.0% male
N = 137
137 patients (25 female, 112 male).
Inclusion criteria: patients with resuscitated comatose out-of-hospital cardiac arrest with suspected cardiac etiology.
Key exclusion criteria: asystole as first monitored rhythm; women of childbearing potential; known treatment limitations; known allergy to methylprednisolone; known pre-arrest mRS score of 4-5.
Interventions
N=68 methylprednisolone (a single IV injection of 250 mg).
N=69 placebo (matching IV placebo).
Primary outcome
Reduction in interleukin 6 blood levels at 24 hours
2.1 pg/mL
29.8 pg/mL
29.8 pg/mL
22.4 pg/mL
14.9 pg/mL
7.5 pg/mL
0.0 pg/mL
Methylprednisolone
Placebo
Significant
decrease ▼
Significantly lower reduction in interleukin 6 blood levels at 24 hours (2.1 pg/mL vs. 29.8 pg/mL; AD -27.7 pg/mL, 95% CI -41.54 to -13.86).
Secondary outcomes
No significant difference in reduction in NSE blood levels at 24 hours (19.1 ug/L vs. 17.2 ug/L; AD 1.9 ug/L, 95% CI -7.04 to 10.84).
Significant increase in survival at day 180 (75% vs. 64%; HR 2.8, 95% CI 1.5 to 5.5).
No significant difference in Cerebral Performance Categories score of 1 at discharge from hospital among patients alive at discharge (58% vs. 76%; RR 0.76, 95% CI -0.32 to 1.84).
Safety outcomes
No significant difference in serious adverse events.
Conclusion
In patients with resuscitated comatose out-of-hospital cardiac arrest with suspected cardiac etiology, methylprednisolone was superior to placebo with respect to reduction in interleukin 6 blood levels at 24 hours.
Reference
Laust E R Obling, Rasmus P Beske, Martin A S Meyer et al. Prehospital high-dose methylprednisolone in resuscitated out-of-hospital cardiac arrest patients (STEROHCA): a randomized clinical trial. Intensive Care Med. 2023 Dec;49(12):1467-1478.
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