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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

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