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Crit Care. 2016 Apr 3;20:82. doi: 10.1186/s13054-016-1257-x.

Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial.

Author information

1
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. mdonnino@bidmc.harvard.edu.
2
Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. mdonnino@bidmc.harvard.edu.
3
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
4
Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
5
Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
6
Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
7
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
8
Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA.
9
Shared Resources, Georgetown University Medical Center, Washington, DC, USA.
10
Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
11
Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
12
Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Abstract

BACKGROUND:

The purpose of this study was to determine whether the provision of corticosteroids improves time to shock reversal and outcomes in patients with post-cardiac arrest shock.

METHODS:

We conducted a randomized, double-blind trial of post-cardiac arrest patients in shock, defined as vasopressor support for a minimum of 1 hour. Patients were randomized to intravenous hydrocortisone 100 mg or placebo every 8 hours for 7 days or until shock reversal. The primary endpoint was time to shock reversal.

RESULTS:

Fifty patients were included with 25 in each group. There was no difference in time to shock reversal between groups (hazard ratio: 0.83 [95% CI: 0.40-1.75], p = 0.63). We found no difference in secondary outcomes including shock reversal (52% vs. 60%, p = 0.57), good neurological outcome (24% vs. 32%, p = 0.53) or survival to discharge (28% vs. 36%, p = 0.54) between the hydrocortisone and placebo groups. Of the patients with a baseline cortisol < 15 ug/dL, 100% (6/6) in the hydrocortisone group achieved shock reversal compared to 33% (1/3) in the placebo group (p = 0.08). All patients in the placebo group died (100%; 3/3) whereas 50% (3/6) died in the hydrocortisone group (p = 0.43).

CONCLUSIONS:

In a population of cardiac arrest patients with vasopressor-dependent shock, treatment with hydrocortisone did not improve time to shock reversal, rate of shock reversal, or clinical outcomes when compared to placebo.

CLINICAL TRIAL REGISTRATION:

Clinicaltrials.gov: NCT00676585, registration date: May 9, 2008.

KEYWORDS:

Adrenal; Cardiac arrest; Hydrocortisone; Shock; Steroids; Vasopressors

PMID:
27038920
PMCID:
PMC4818959
DOI:
10.1186/s13054-016-1257-x
[Indexed for MEDLINE]
Free PMC Article

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