title: Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study.
abstract: BACKGROUND
  Circulatory failure during brain death organ donor resuscitation is a problem that compromises recovery of organs. Combined administration of steroid, thyroxine and vasopressin has been proposed to optimize the management of brain deceased donors before recovery of organs. However the single administration of hydrocortisone has not been rigorously evaluated in any trial.
  
  
  METHODS
  In this prospective multicenter cluster study, 259 subjects were included. Administration of low-dose steroids composed the steroid group (n = 102).
  
  
  RESULTS
  Although there were more patients in the steroid group who received norepinephrine before brain death (80% vs. 66%: P = 0.03), mean dose of vasopressor administered after brain death was significantly lower than in the control group (1.18 ± 0.92 mg/H vs. 1.49 ± 1.29 mg/H: P = 0.03), duration of vasopressor support use was shorter (874 min vs. 1160 min: P < 0.0001) and norepinephrine weaning before aortic clamping was more frequent (33.8% vs. 9.5%: P < 0.0001). Using a survival approach, probability of norepinephrine weaning was significantly different between the two groups (P < 0.0001) with a probability of weaning 4.67 times higher in the steroid group than in the control group (95% CI: 2.30 - 9.49).
  
  
  CONCLUSIONS
  Despite no observed benefits of the steroid administration on primary function recovery of transplanted grafts, administration of glucocorticoids should be a part of the resuscitation management of deceased donors with hemodynamic instability.
authors: Michel
authors: M
authors: Pinsard
authors: Stéphanie
authors: S
authors: Ragot
authors: Paul Michel
authors: PM
authors: Mertes
authors: Jean Paul
authors: JP
authors: Bleichner
authors: Samira
authors: S
authors: Zitouni
authors: Fabrice
authors: F
authors: Cook
authors: Marc
authors: M
authors: Pierrot
authors: Laurent
authors: L
authors: Dube
authors: Edgard
authors: E
authors: Menguy
authors: Laurent Martin
authors: LM
authors: Lefèvre
authors: Laurence
authors: L
authors: Escaravage
authors: Pierre-François
authors: PF
authors: Dequin
authors: Philippe
authors: P
authors: Vignon
authors: Nicolas
authors: N
authors: Pichon
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001926:Brain Death; D005260:Female; D005602:France; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008771:Nordefrin / Q000008:administration & dosage*; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods; D012769:Shock; D018709:Statistics, Nonparametric; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014667:Vasopressins / Q000008:administration & dosage*
chemical_list: D000893:Anti-Inflammatory Agents; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D008771:Nordefrin; D006854:Hydrocortisone