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- Title
Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial.
- Authors
Donnino, Michael W.; Andersen, Lars W.; Berg, Katherine M.; Chase, Maureen; Sherwin, Robert; Smithline, Howard; Carney, Erin; Long Ngo; Patel, Parth V.; Xiaowen Liu; Cutlip, Donald; Zimetbaum, Peter; Cocchi, Michael N.; Ngo, Long; Liu, Xiaowen; collaborating authors from the Beth Israel Deaconess Medical Center’s Center for Resuscitation Science Research Group
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.<bold>Clinical Trial Registration: </bold>Clinicaltrials.gov: NCT00676585, registration date: May 9, 2008.
- Subjects
CARDIAC arrest; COMPARATIVE studies; CARDIOPULMONARY resuscitation; HYDROCORTISONE; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH funding; SHOCK (Pathology); SURVIVAL; TIME; EVALUATION research; VASOCONSTRICTORS; RANDOMIZED controlled trials; TREATMENT effectiveness; PROPORTIONAL hazards models; BLIND experiment; THERAPEUTICS
- Publication
Critical Care, 2016, Vol 20, p82
- ISSN
1364-8535
- Publication type
journal article
- DOI
10.1186/s13054-016-1257-x