title: Glucocorticoid use during cardiopulmonary resuscitation may be beneficial for cardiac arrest.
abstract: BACKGROUND
  Various studies have indicated that glucocorticoid supplementation during cardiopulmonary resuscitation (CPR), in conjunction with vasopressors, may improve outcomes in instances of cardiac arrest. However, further population-based analysis is warranted with respect to resuscitative and long-term survival benefits conferred by administering glucocorticoids in this setting.
  
  
  METHODS
  A total of 145,644 adult patients who experienced non-traumatic, cardiac arrest occurred at emergency room during years 2004-2011 were selected for study from the Taiwan National Health Insurance Research database. These patients were grouped as steroid and non-steroid recipients during CPR, and group members were matched in terms of patient characteristics, including presenting complaint, prior steroid use, resuscitative drugs and shocks delivered, treatment setting (medical center or not), socioeconomic status, and year that cardiac arrest occurred, through propensity scoring. Logistic regression analysis was performed to determine the impact of steroid usage on survival to admission, survival to discharge, and 1-year survival.
  
  
  RESULTS
  Compared with matched non-steroid group members (n=8628), patients given steroid (n=2876) displayed significantly higher rates of survival to admission (38.32% vs 18.67%; adjusted OR=2.97, 95% CI 2.69-3.29; p<0.0001), survival to discharge (14.50% vs 5.61%; adjusted OR=1.71, 95% CI 1.42-2.05; p<0.0001), and 1-year overall survival (10.81% vs 4.74%; adjusted OR=1.48, 95% CI 1.22-1.79; p<0.0001). Steroid use proved more beneficial in patients with COPD or asthma and in the absence of shockable rhythm during CPR.
  
  
  CONCLUSIONS
  Glucocorticoid use during CPR is associated with improved survival-to-admission, survival-to-discharge, and 1-year survival rates.
authors: Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan. Electronic address: mshanmshan@gmail.com.
authors: Min-Shan
authors: MS
authors: Tsai
authors: School of Health Care Administration, Taipei Medical University, Taipei, Taiwan. Electronic address: poyachua@usc.edu.
authors: Po-Ya
authors: PY
authors: Chuang
authors: Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan. Electronic address: ambigus39@gmail.com.
authors: Ping-Hsun
authors: PH
authors: Yu
authors: Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan. Electronic address: chhuang730@ntu.edu.tw.
authors: Chien-Hua
authors: CH
authors: Huang
authors: School of Health Care Administration, Taipei Medical University, Taipei, Taiwan. Electronic address: chtang@tmu.edu.tw.
authors: Chao-Hsiun
authors: CH
authors: Tang
authors: Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan. Electronic address: wtchang@ntu.edu.tw.
authors: Wei-Tien
authors: WT
authors: Chang
authors: Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan; Department of Emergency Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan. Electronic address: wjchen1955@ntu.edu.tw.
authors: Wen-Jone
authors: WJ
authors: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality* / Q000639:trends; D016208:Databases, Factual / Q000639:trends; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006323:Heart Arrest / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Glucocorticoid; Propensity score; Survival; Taiwan National Health Insurance Research database