title: Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT00676585, registration date: May 9, 2008.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. mdonnino@bidmc.harvard.edu.|Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. mdonnino@bidmc.harvard.edu.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.|Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars W
authors.initials: LW
authors.lastname: Andersen
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Berg
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Chase
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Sherwin
authors.affiliation: Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Smithline
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Shared Resources, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Carney
authors.affiliation: Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Long
authors.initials: L
authors.lastname: Ngo
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Parth V
authors.initials: PV
authors.lastname: Patel
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Xiaowen
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Cutlip
authors.affiliation: Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Zimetbaum
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012769:Shock / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D006854:Hydrocortisone
keywords: Adrenal; Cardiac arrest; Hydrocortisone; Shock; Steroids; Vasopressors