Relative adrenal insufficiency after cardiac arrest: impact on postresuscitation disease outcome.
The purpose of this study is to prospectively evaluate the cortisol response and determine the relative adrenal insufficiency after return of spontaneous circulation (ROSC).


METHODS
This is a prospective cohort study describing the prevalence of relative adrenal insufficiency in consecutive patients admitted to an intensive care unit following ROSC (>24 hours) after cardiac arrest. The study institution is a 1,300-bed urban hospital with an annual intensive care unit census of 80. Descriptive statistics is used to report results.


RESULTS
This study included 30 patients over a 1-year period. The mean patient age was 52 years, and there were 15 (50%) males. The most common etiology for cardiac arrest was unknown, and the most common initial rhythm was asystole. There were 16 (53%) witnessed arrests. The mean time from arrest to cardiopulmonary resuscitation was 8 minutes, and the mean time from arrest to ROSC was 23 minutes. Relative adrenal insufficiency (incremental response to corticotrophin test < 9 microg/dL) at initial 12 to 24 hours and >24 to 48 hours occurred in 13 (43%) and 10 (33%) patients, respectively. All basal cortisol values were normal to high. Nineteen (58%) patients survived. The mean cortisol values at the initial 12 to 24 hours and >24 to 48 hours were similar among survivors and nonsurvivors. Relative adrenal insufficiency was present in only 5 (26%) survivors.


CONCLUSIONS
Relative adrenal insufficiency may be associated with the increased mortality rate in patients with return of circulation after cardiac arrest. Although basal cortisol values were normal to high, treatment of relative adrenal insufficiency with corticosteroids may decrease the mortality rate. Additional studies are needed to confirm this association and to determine the effectiveness of treating relative adrenal insufficiency.
Kim
Jin Ju
JJ
Department of Emergency Medicine, Gachon Medical School Gil Medical Center, Incheon 405-760, South Korea.
Lim
Yong Su
YS
Shin
Jong Hwan
JH
Yang
Hyuk Jun
HJ
Kim
Jae Kwang
JK
Hyun
Sung Youl
SY
Rhoo
Ill
I
Hwang
Sung Youn
SY
Lee
Gun
G
D000293:Adolescent; D000309:Adrenal Insufficiency / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D016887:Cardiopulmonary Resuscitation; D016009:Chi-Square Distribution; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D006854:Hydrocortisone