Glucocorticoid treatment does not improve neurological recovery following cardiac arrest. Brain Resuscitation Clinical Trial I Study Group.
Glucocorticoids are commonly given to patients with global brain ischemia, although their efficacy has not been proved. The database of the Brain Resuscitation Clinical Trial I, a multi-institutional study designed to evaluate the effect of thiopental sodium therapy on neurological outcome following brain ischemia, was used for a retrospective review of the effects of glucocorticoid treatment on neurological outcome after global brain ischemia. This study included 262 initially comatose cardiac arrest survivors who made no purposeful response to pain after restoration of spontaneous circulation. The standard treatment protocol left glucocorticoid therapy to the discretion of the hospital investigators. This resulted in four patient groups that received either no, low, medium, or high doses of glucocorticoids in the first 8 hours after arrest. Neurological outcome was scored using a modification of the Glasgow Cerebral Performance Category Scale. None of the steroid regimens statistically improved mean group survival rate or neurological recovery rate over that observed in the group that did not receive steroids. The routine clinical practice of administrating glucocorticoids after global brain ischemia may be associated with serious complications and is not justified.
Jastremski
M
M
International Resuscitation Research Center, University of Pittsburgh, Pa.
Sutton-Tyrrell
K
K
Vaagenes
P
P
Abramson
N
N
Heiselman
D
D
Safar
P
P
D000368:Aged; D001623:Betamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006323:Heart Arrest / Q000150:complications* / Q000401:mortality; D006801:Humans; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D012189:Retrospective Studies
D005938:Glucocorticoids; D008776:Methylprednisolone Hemisuccinate; D003907:Dexamethasone; D001623:Betamethasone