The effect of hydrocortisone on the outcome of out-of-hospital cardiac arrest patients: a pilot study.
OBJECTIVE
Several studies have disclosed the importance of serum adrenocorticotropic hormone and cortisol levels in resuscitation. The objective of this study was to observe the effect of hydrocortisone on the outcome of out-of-hospital cardiac arrest (OHCA) patients.


METHODS
Prospective, nonrandomized, open-labeled clinical trial.


METHODS
Emergency department (ED) of National Taiwan University Hospital.


METHODS
Ninety-seven nontraumatic adult OHCA victims.


METHODS
Serum adrenocorticotropic hormone and total cortisol levels were examined in all patients. The hydrocortisone group (n = 36) received 100 mg intravenous hydrocortisone during resuscitation, and the nonhydrocortisone group (n = 61) received 0.9% saline as placebo.


RESULTS
Comparison of return of the spontaneous circulation (ROSC) rates between the 2 groups was analyzed. The hydrocortisone group had a significantly higher ROSC rate than the nonhydrocortisone group (61% vs 39%, P = .038). Hydrocortisone administration within 6 minutes after ED arrival led to an increased ROSC rate (90% vs 50%, P = .045). The hydrocortisone and nonhydrocortisone groups did not differ in the development of electrolyte disturbances, gastrointestinal tract bleeding, or infection during early postresuscitation period (gastrointestinal bleeding: 41% vs 46%, P = .89; infection: 50% vs 75%, P = .335). There was no significant difference between the hydrocortisone and nonhydrocortisone groups in terms of 1- and 7-day survival and hospital discharge rates.


CONCLUSIONS
Hydrocortisone treatment during resuscitation, particularly when administrated within 6 minutes of ED arrival, may be associated with an improved ROSC rate in OHCA patients.
Tsai
Min-Shan
MS
Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, Taipei 100, Taiwan.
Huang
Chien-Hua
CH
Chang
Wei-Tien
WT
Chen
Wen-Jone
WJ
Hsu
Chiung-Yuan
CY
Hsieh
Cheng-Chun
CC
Yang
Chih-Wei
CW
Chiang
Wen-Chu
WC
Ma
Matthew Huei-Ming
MH
Chen
Shyr-Chyr
SC
D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D010865:Pilot Projects; D011188:Potassium / Q000097:blood; D012151:Resuscitation / Q000379:methods*; D012964:Sodium / Q000097:blood; D013624:Taiwan
D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D012964:Sodium; D011188:Potassium; D006854:Hydrocortisone