Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial

Crit Care. 2016 Apr 3;20:82. doi: 10.1186/s13054-016-1257-x.

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.

Clinical trial registration: Clinicaltrials.gov: NCT00676585, registration date: May 9, 2008.

Keywords: Adrenal; Cardiac arrest; Hydrocortisone; Shock; Steroids; Vasopressors.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Resuscitation / methods
  • Double-Blind Method
  • Female
  • Heart Arrest / drug therapy*
  • Heart Arrest / mortality
  • Humans
  • Hydrocortisone / administration & dosage
  • Hydrocortisone / adverse effects
  • Hydrocortisone / therapeutic use*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Shock / drug therapy*
  • Shock / mortality
  • Survival Rate
  • Time Factors
  • Treatment Outcome
  • Vasoconstrictor Agents / adverse effects
  • Vasoconstrictor Agents / therapeutic use*

Substances

  • Vasoconstrictor Agents
  • Hydrocortisone

Associated data

  • ClinicalTrials.gov/NCT00676585