{
  "abstract": "Introduction After resuscitation from out of hospital cardiac arrest (OHCA), mechanical ventilation (MV) and respiratory management are fundamental to support patients in the intensive care unit (ICU) and to minimise secondary brain injury. Best practices for MV and association with clinical outcomes in patients with OHCA remain unclear.Methods and analysis This protocol describes a pre-planned respiratory-focused series of sub-analyses within the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) trial, an ongoing interventional study evaluating 6-month mortality after randomisation in patients admitted to ICUs following OHCA. The primary aim is to describe real-world ventilator settings and gas-exchange targets during the first 72 hours after ICU admission in patients receiving invasive mechanical ventilation after OHCA. Secondary aims include to estimate the incidence of respiratory complications during ICU stay (eg, ventilator-associated pneumonia, acute respiratory distress syndrome, barotrauma); and to explore the association between early ventilator settings/gas-exchange parameters and 6-month outcomes (mortality and neurological status). Exploratory aim is to characterise weaning and extubation practices, including timing and failure rates.Eligible patients will include adult STEPCARE participants receiving invasive MV after return of spontaneous circulation with available respiratory data recorded within the STEPCARE database.Data collected in the STEPCARE trial that will be analysed include patients’ prehospital characteristics; clinical examination at hospital admission and at ICU admission; ventilator settings and arterial blood gases recorded at predefined time points during ICU stay. In particular: MV setting (mode, tidal volume, positive end-expiratory pressure, fraction of inspired oxygen, tidal volume, mechanical power, plateau/driving pressures), gas-exchange values (arterial partial pressure of oxygen and carbon dioxide, pH, arterial saturation of oxygen), timing of measurements and the occurrence/timing of respiratory complications and weaning outcomes.Ethics and dissemination The STEPCARE study has been approved by the regional ethics committee at Lund University (Dnr 2022-02425-01, Approved IRB on 2022-06-18) and by all ethics boards in the participating countries. No additional ethical approval is required for this predefined secondary analysis, as no further data collection or interventions will be performed. Findings will be disseminated through publication in peer-reviewed journals and, where appropriate, conference abstracts and presentations. Patients and the public were not involved.ClinicalTrials.gov NCT05564754.",
  "authors": [
    {
      "affiliations": [
        "Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Liguria, Italy",
        "Anesthesia and Intensive Care, IRCCS Azienda Ospedaliera Metropolitana, Genoa, Italy"
      ],
      "name": "Denise Battaglini"
    },
    {
      "affiliations": [
        "Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Liguria, Italy"
      ],
      "name": "Francesca Gualdi"
    },
    {
      "affiliations": [
        "Servizio di Anestesia e Rianimazione Generale, Azienda Ospedaliero Universitaria di Alessandria, Alessandria, Italy"
      ],
      "name": "Gianmaria Cammarota"
    },
    {
      "affiliations": [
        "Wellcome–Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland, UK",
        "Regional Intensive Care Unit, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK"
      ],
      "name": "Peter J McGuigan"
    },
    {
      "affiliations": [
        "Intensive Care Unit, University Hospitals Bristol and Weston, Bristol, UK"
      ],
      "name": "Matthew Thomas"
    },
    {
      "affiliations": [
        "Department of Anaesthesia and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"
      ],
      "name": "Markus B. Skrifvars"
    },
    {
      "affiliations": [
        "Department of Anaesthesia and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"
      ],
      "name": "Ville H. Niemelä"
    },
    {
      "affiliations": [
        "Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland",
        "Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland"
      ],
      "name": "Matti Reinikainen"
    },
    {
      "affiliations": [
        "Critical Care Program, The George Institute for Global Health, UNSW Sydney, NSW, Australia",
        "Malcom Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, NWS, Australia"
      ],
      "name": "Frances Bass"
    },
    {
      "affiliations": [
        "Intensive Care Unit, Wellington Hospital, Wellington, New Zealand",
        "Medical Research Institute of New Zealand, Wellington, Wellington, New Zealand",
        "Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia",
        "Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Paul J Young"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden",
        "Department of Neurology, Skåne University Hospital Lund, Lund, Skåne County, Sweden"
      ],
      "name": "Gisela Lilja"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences Lund, Cardiology, Lund University, Skåne University Hospital Lund, Lund, Skåne County, Sweden",
        "Department of Cardiology, Skåne University Hospital, Lund, Sweden"
      ],
      "name": "Josef Dankiewicz"
    },
    {
      "affiliations": [
        "Critical Care Program, The George Institute for Global Health, UNSW Sydney, NSW, Australia",
        "Malcom Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, NWS, Australia"
      ],
      "name": "Naomi E. Hammond"
    },
    {
      "affiliations": [
        "Department of Anaesthesia and Intensive Care, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland",
        "Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"
      ],
      "name": "Johanna Hästbacka"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences Lund, Lund University, Lund, Skåne County, Sweden",
        "Department of Research, Development, Education and Innovation (R&DEI), Skåne University Hospital Lund, Lund, Skåne County, Sweden"
      ],
      "name": "Helena Levin"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden",
        "Department of Neurological Rehabilitation, Skåne University Hospital Lund, Lund, Sweden"
      ],
      "name": "Marion Moseby-Knappe"
    },
    {
      "affiliations": [
        "Critical Care Program, The George Institute for Global Health, UNSW Sydney, NSW, Australia",
        "Department of Intensive Care Medicine, St George Hospital, Sydney, NSW, Australia"
      ],
      "name": "Manoj Saxena"
    },
    {
      "affiliations": [
        "Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"
      ],
      "name": "Marjaana Tiainen"
    },
    {
      "affiliations": [
        "Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark"
      ],
      "name": "Caroline Barkholt Kamp"
    },
    {
      "affiliations": [
        "Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark",
        "Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark",
        "Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Region Zealand, Denmark"
      ],
      "name": "Christina Dam Bjerregaard Sillassen"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Helsingborg, Lund University, Helsingborg, Sweden",
        "Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden"
      ],
      "name": "Joachim Düring"
    },
    {
      "affiliations": [
        "Department of Anesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital Division of Emergencies and Critical Care, Oslo, Norway",
        "Lovisenberg Diaconal University College, Oslo, Norway"
      ],
      "name": "Luis G Romundstad"
    },
    {
      "affiliations": [
        "Department of Anaesthesia and Intensive Care Medicine, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg",
        "Department of Health, Medicine Life Sciences, University of Luxembourg, Faculty of Science Technology and Medicine, Esch-sur-Alzette, Luxembourg"
      ],
      "name": "Stammet Pascal"
    },
    {
      "affiliations": [
        "Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany"
      ],
      "name": "Christoph Leithner"
    },
    {
      "affiliations": [
        "Department of Adult Critical Care, University Hospital of Wales, Cardiff, UK"
      ],
      "name": "Matt P. Wise"
    },
    {
      "affiliations": [
        "Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland"
      ],
      "name": "Matthias Haenggi"
    },
    {
      "affiliations": [
        "Department of Adult Critical Care, University Hospital of Wales, Cardiff, UK"
      ],
      "name": "Jade Cole"
    },
    {
      "affiliations": [
        "Department of Adult Critical Care, University Hospital of Wales, Cardiff, UK"
      ],
      "name": "Joe Riddell"
    },
    {
      "affiliations": [
        "Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark",
        "Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Janus C. Jakobsen"
    },
    {
      "affiliations": [
        "Anesthesiology and Intensive Care, Department of Clinical Sciences Lund, Lund University, Lund, Skåne County, Sweden",
        "Department of Clinical Sciences, Lund University Campus Helsingborg, Helsingborg, Skåne County, Sweden"
      ],
      "name": "Niklas Nielsen"
    },
    {
      "affiliations": [
        "Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Liguria, Italy",
        "Anesthesia and Intensive Care, IRCCS Azienda Ospedaliera Metropolitana, Genoa, Italy"
      ],
      "name": "Nicolò Antonino Patroniti"
    },
    {
      "affiliations": [
        "Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Liguria, Italy",
        "Anesthesia and Intensive Care, IRCCS Azienda Ospedaliera Metropolitana, Genoa, Italy"
      ],
      "name": "Chiara Robba"
    }
  ],
  "title": "Ventilation strategies and outcomes after out-of-hospital cardiac arrest: protocol for a pre-planned sub-analysis of the STEPCARE trial",
  "uid": "8b829723-66cb-53cf-88fa-a9a0e55a4061"
}