Sedation, Temperature and Pressure After Cardiac Arrest and Resuscitation

NCT ID: NCT05564754

Last Updated: 2025-07-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

3500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-08-17

Study Completion Date

2026-12-31

Brief Summary

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The STEPCARE-trial is a 2x2x2 randomised trial studying patients who have been resuscitated from cardiac arrest and who are comatose. It will include three different interventions focusing on sedation targets, temperature targets and mean arterial pressure targets.

Detailed Description

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3500 patients who are comatose after cardiac arrest will be included in a trial studying three separate targets. All patients will be randomised to a control or an intervention arm for sedation, temperature and blood pressure targets. These are.

1. Continuous deep sedation for 36 hours or minimal sedation (SEDCARE)
2. Fever management with or without a feedback-controlled device (TEMPCARE)
3. A mean arterial pressure target of \>85mmHg or \>65mmHg. (MAPCARE)

Participants will be followed up at 30 days and 6 months. The primary outcome will be survival at 6 months.

Conditions

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Cardiac Arrest With Successful Resuscitation Hypoxia, Brain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

2x2x2 factorial, with all patients taking part in each factor.
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
Participants will be blinded. Assessors of neurological prognosis will be blinded. Outcome assessors and investigators will be blinded. Health-care personnel will not be blinded.

Study Groups

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Sedation, temperature device and high MAP

Continuous deep sedation for 36 hours Fever management with a feedback-controlled device if temperature above 37.7°C. A mean arterial pressure target of \>85mmHg.

Group Type ACTIVE_COMPARATOR

Feedback-controlled temperature device

Intervention Type DEVICE

If core body temperature exceeds 37.7°C a feedback controlled-device will be used and set at 37.5°C.

High MAP

Intervention Type OTHER

A MAP target of \>85mmHg will be used. Vasopressors will be titrated to this target during 36h.

Deep sedation

Intervention Type OTHER

Deep sedation for at least 36h

Sedation, no temperature device and high MAP

Continuous deep sedation for 36 hours. Fever management without a feedback-controlled device. A mean arterial pressure target of \>85mmHg.

Group Type ACTIVE_COMPARATOR

High MAP

Intervention Type OTHER

A MAP target of \>85mmHg will be used. Vasopressors will be titrated to this target during 36h.

Deep sedation

Intervention Type OTHER

Deep sedation for at least 36h

Fever control without a device

Intervention Type OTHER

Management of fever in the ICU without a device

Sedation, temperature device and low MAP

Continuous deep sedation for 36 hours. Fever management with a feedback-controlled device if temperature above 37.7°C. A mean arterial pressure target of \>65mmHg.

Group Type ACTIVE_COMPARATOR

Feedback-controlled temperature device

Intervention Type DEVICE

If core body temperature exceeds 37.7°C a feedback controlled-device will be used and set at 37.5°C.

Deep sedation

Intervention Type OTHER

Deep sedation for at least 36h

Low MAP

Intervention Type OTHER

A MAP target of \>65mmHg will be used. Vasopressors will be titrated to this target during 36h.

Sedation, no temperature device and low MAP

Continuous deep sedation for 36 hours. Fever management without a feedback-controlled device. A mean arterial pressure target of \>65mmHg.

Group Type ACTIVE_COMPARATOR

Deep sedation

Intervention Type OTHER

Deep sedation for at least 36h

Fever control without a device

Intervention Type OTHER

Management of fever in the ICU without a device

Low MAP

Intervention Type OTHER

A MAP target of \>65mmHg will be used. Vasopressors will be titrated to this target during 36h.

Minimal sedation, temperature device and high MAP

Minimal sedation (and early extubation if possible). Fever management with a feedback-controlled device if temperature above 37.7°C. A mean arterial pressure target of \>85mmHg.

Group Type ACTIVE_COMPARATOR

Feedback-controlled temperature device

Intervention Type DEVICE

If core body temperature exceeds 37.7°C a feedback controlled-device will be used and set at 37.5°C.

High MAP

Intervention Type OTHER

A MAP target of \>85mmHg will be used. Vasopressors will be titrated to this target during 36h.

Minimal sedation

Intervention Type OTHER

A strategy of minimal sedation in the ICU, used only as needed to facilitate transport, imaging and invasive procedures.

Minimal sedation, no temperature device and high MAP

Minimal sedation (and early extubation if possible). Fever management without a feedback-controlled device. A mean arterial pressure target of \>65mmHg.

Group Type ACTIVE_COMPARATOR

High MAP

Intervention Type OTHER

A MAP target of \>85mmHg will be used. Vasopressors will be titrated to this target during 36h.

Fever control without a device

Intervention Type OTHER

Management of fever in the ICU without a device

Minimal sedation

Intervention Type OTHER

A strategy of minimal sedation in the ICU, used only as needed to facilitate transport, imaging and invasive procedures.

Minimal sedation, temperature device and low MAP

Minimal sedation (and early extubation if possible). Fever management with a feedback-controlled device if temperature above 37.7°C. A mean arterial pressure target of \>65mmHg.

Group Type ACTIVE_COMPARATOR

Feedback-controlled temperature device

Intervention Type DEVICE

If core body temperature exceeds 37.7°C a feedback controlled-device will be used and set at 37.5°C.

Low MAP

Intervention Type OTHER

A MAP target of \>65mmHg will be used. Vasopressors will be titrated to this target during 36h.

Minimal sedation

Intervention Type OTHER

A strategy of minimal sedation in the ICU, used only as needed to facilitate transport, imaging and invasive procedures.

Minimal sedation, no temperature device and low MAP

Minimal sedation (and early extubation if possible). Fever management without a feedback-controlled device. A mean arterial pressure target of \>65mmHg.

Group Type ACTIVE_COMPARATOR

Fever control without a device

Intervention Type OTHER

Management of fever in the ICU without a device

Low MAP

Intervention Type OTHER

A MAP target of \>65mmHg will be used. Vasopressors will be titrated to this target during 36h.

Minimal sedation

Intervention Type OTHER

A strategy of minimal sedation in the ICU, used only as needed to facilitate transport, imaging and invasive procedures.

Interventions

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Feedback-controlled temperature device

If core body temperature exceeds 37.7°C a feedback controlled-device will be used and set at 37.5°C.

Intervention Type DEVICE

High MAP

A MAP target of \>85mmHg will be used. Vasopressors will be titrated to this target during 36h.

Intervention Type OTHER

Deep sedation

Deep sedation for at least 36h

Intervention Type OTHER

Fever control without a device

Management of fever in the ICU without a device

Intervention Type OTHER

Low MAP

A MAP target of \>65mmHg will be used. Vasopressors will be titrated to this target during 36h.

Intervention Type OTHER

Minimal sedation

A strategy of minimal sedation in the ICU, used only as needed to facilitate transport, imaging and invasive procedures.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Out-of-hospital cardiac arrest
2. Sustained ROSC - defined as 20 minutes with signs of circulation without the need for chest compressions
3. Unconsciousness defined as not being able to obey verbal commands (FOUR-score motor response of \<4) or being intubated and sedated because of agitation after sustained ROSC.
4. Eligible for intensive care without restrictions or limitations
5. Inclusion within 4 hours of ROSC

Exclusion Criteria

1. On ECMO prior to randomization
2. Pregnancy
3. Suspected or confirmed intracranial hemorrhage
4. Previously randomized in the STEPCARE trial
5. Trauma or hemorrhage being the presumed cause of arrest
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Lund University, Lund, Sweden

UNKNOWN

Sponsor Role collaborator

Copenhagen Trial Unit, Center for Clinical Intervention Research

OTHER

Sponsor Role collaborator

The George Institute for Global Health, Australia

OTHER

Sponsor Role collaborator

HUS Helsinki University Hospitals, Helsinki, Finland

UNKNOWN

Sponsor Role collaborator

Medical Research Institute of New Zealand Rangahautia Te Ora, Wellington, New Zealand

UNKNOWN

Sponsor Role collaborator

University Hospital of Wales

OTHER

Sponsor Role collaborator

Region Skane

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Niklas Nielsen, PhD

Role: STUDY_CHAIR

Lund University

Locations

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Nepean Hospital

Kingswood, New South Wales, Australia

Site Status RECRUITING

Liverpool Hospital

Liverpool, New South Wales, Australia

Site Status RECRUITING

Royal North Shore Hospital

Sydney, New South Wales, Australia

Site Status RECRUITING

St George Hospital

Sydney, New South Wales, Australia

Site Status RECRUITING

The Sutherland Hospital

Sydney, New South Wales, Australia

Site Status RECRUITING

Princess Alexandra Hospital

Brisbane, Queensland, Australia

Site Status RECRUITING

The Prince Charles Hospital

Brisbane, Queensland, Australia

Site Status RECRUITING

Austin Hospital

Melbourne, Victoria, Australia

Site Status RECRUITING

HUB Hôpital Erasme

Brussels, , Belgium

Site Status RECRUITING

Ghent University Hospital

Ghent, , Belgium

Site Status RECRUITING

Ziekenhuis Oost-Limburg Hospital

Lanaken, , Belgium

Site Status RECRUITING

North Estonia Medical Centre, Tallinn

Tallinn, , Estonia

Site Status RECRUITING

Jorvi Hospital

Espoo, , Finland

Site Status RECRUITING

Meilahti Hospital

Helsinki, , Finland

Site Status RECRUITING

Helsinki Helsingforgs University Central Hospital

Helsinki, , Finland

Site Status RECRUITING

Jyväskylä Hospital

Jyväskylä, , Finland

Site Status RECRUITING

Kuopio University Hospital

Kuopio, , Finland

Site Status RECRUITING

Oulu University Hospital

Oulu, , Finland

Site Status RECRUITING

Tampere University Hospital

Tampere, , Finland

Site Status RECRUITING

Charite University Hospital

Berlin, , Germany

Site Status RECRUITING

Lübeck University Hospital

Lübeck, , Germany

Site Status RECRUITING

Tubingen University Hospital

Tübingen, , Germany

Site Status RECRUITING

St Vincents University Hospital

Dublin, , Ireland

Site Status ACTIVE_NOT_RECRUITING

San Martino Hospital Genova

Genova, , Italy

Site Status RECRUITING

Centre Hospitalier de Luxembourg

Luxembourg, , Luxembourg

Site Status RECRUITING

DCCM ICU

Auckland, , New Zealand

Site Status RECRUITING

Middlemore ICU

Auckland, , New Zealand

Site Status RECRUITING

North Shore ICU NZ

Auckland, , New Zealand

Site Status RECRUITING

Christchurch Hospital

Christchurch, , New Zealand

Site Status RECRUITING

Whangarei ICU

Northland, , New Zealand

Site Status ACTIVE_NOT_RECRUITING

Wellington Hospital

Wellington, , New Zealand

Site Status RECRUITING

Soerlandet Hospital Arendal

Arendal, , Norway

Site Status RECRUITING

Kalnes Hospital

Kalnes, , Norway

Site Status RECRUITING

Oslo University Hospital

Oslo, , Norway

Site Status RECRUITING

Stavanger University Hospital

Stavanger, , Norway

Site Status RECRUITING

King Abdulaziz Medical City

Riyadh, , Saudi Arabia

Site Status RECRUITING

Tan Tock Seng Hospital

Singapore, , Singapore

Site Status RECRUITING

Hallands hospital

Halmstad, Halland County, Sweden

Site Status RECRUITING

Helsingborg Hospital

Helsingborg, Skåne County, Sweden

Site Status RECRUITING

Skåne University Hospital

Lund, Skåne County, Sweden

Site Status RECRUITING

Skåne University Hospital Malmö

Malmo, Skåne County, Sweden

Site Status RECRUITING

Sahlgrenska University Hospital

Gothenburg, , Sweden

Site Status RECRUITING

Karlstad hospital

Karlstad, , Sweden

Site Status RECRUITING

Skaraborg Hospital Skovde

Skövde, , Sweden

Site Status RECRUITING

Karolinska University Hospital

Stockholm, , Sweden

Site Status RECRUITING

University Hospital of Umeå

Umeå, , Sweden

Site Status RECRUITING

Bern University Hospital

Bern, , Switzerland

Site Status RECRUITING

St Gallen Hospital

Sankt Gallen, , Switzerland

Site Status RECRUITING

University Hospital Zürich

Zurich, , Switzerland

Site Status RECRUITING

Essex Cardiothoracic Centre

Basildon, , United Kingdom

Site Status RECRUITING

Bristol Royal Infirmary

Bristol, , United Kingdom

Site Status RECRUITING

Cardiff University Hospital

Cardiff, , United Kingdom

Site Status RECRUITING

Leeds General Infirmary

Leeds, , United Kingdom

Site Status RECRUITING

Kings College Hospital

London, , United Kingdom

Site Status RECRUITING

St Bartholomew's Hospital

London, , United Kingdom

Site Status RECRUITING

St Georges University Hospital

London, , United Kingdom

Site Status RECRUITING

Countries

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Australia Belgium Estonia Finland Germany Ireland Italy Luxembourg New Zealand Norway Saudi Arabia Singapore Sweden Switzerland United Kingdom

Central Contacts

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Josef Dankiewicz, PhD

Role: CONTACT

+464671000

Niklas Nielsen, PhD

Role: CONTACT

+46424061000

Facility Contacts

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Ian Seppelt, Dr

Role: primary

Antony Stewart, Dr.

Role: primary

Wade Stedman, Dr

Role: primary

Manoj Saxena, Dr

Role: primary

Anas Naeem, Dr

Role: primary

James Walsham, Dr

Role: primary

Denzil Gill, Dr

Role: primary

Rinaldo Bellomo, Prof

Role: primary

Fabio Taccone

Role: primary

Patrick Druwe

Role: primary

Koen Ameloot

Role: primary

Martin Lotman

Role: primary

Tuomas Oksanen

Role: primary

Ville Niemelä

Role: primary

Markus Skrifvars, PhD

Role: primary

Matti Reinikainen, PhD

Role: primary

Timo Kaakinen

Role: primary

Joonas Tirkkonen

Role: primary

Jens Nee

Role: primary

Tobias Graf

Role: primary

Annerose Mengel

Role: primary

Chiara Robba

Role: primary

Pascal Stammet, MD, PdH

Role: primary

Tony Williams

Role: primary

David Knight

Role: primary

Paul Young

Role: primary

Elisabeth Nøst

Role: primary

Martin S Hansen

Role: primary

Luis G Romundstad

Role: primary

Philipp Seidel

Role: primary

Yaseen Arabi

Role: primary

Chia Y Woon

Role: primary

Johan Undén, MD, PhD

Role: primary

Jesper Johnsson, MD,PhD

Role: primary

Anna Lybeck, MD,PhD

Role: primary

Joachim Düring, MD,PhD

Role: primary

Andreas Lundin

Role: primary

Jon Rosell

Role: primary

Daniel R Santos

Role: primary

Jessica Kåhlin

Role: primary

Matthias Schien

Role: primary

Manuela Iten

Role: primary

Claudia Schrag

Role: primary

Matthias Hilty

Role: primary

Thomas Keeble

Role: primary

Matt Thomas

Role: primary

Matt Wise

Role: primary

Phil Jackson

Role: primary

Nelish Pereek

Role: primary

Alistair Proudfoot

Role: primary

Rhodri Handslip

Role: primary

Related Links

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http://stepcare.org

Trial webpage

Other Identifiers

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step2022

Identifier Type: -

Identifier Source: org_study_id

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