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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

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

Authors: Michael W. Donnino, Lars W. Andersen, Katherine M. Berg, Maureen Chase, Robert Sherwin, Howard Smithline, Erin Carney, Long Ngo, Parth V. Patel, Xiaowen Liu, Donald Cutlip, Peter Zimetbaum, Michael N. Cocchi, the collaborating authors from the Beth Israel Deaconess Medical Center’s Center for Resuscitation Science Research Group

Published in: Critical Care | Issue 1/2016

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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.
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Metadata
Title
Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial
Authors
Michael W. Donnino
Lars W. Andersen
Katherine M. Berg
Maureen Chase
Robert Sherwin
Howard Smithline
Erin Carney
Long Ngo
Parth V. Patel
Xiaowen Liu
Donald Cutlip
Peter Zimetbaum
Michael N. Cocchi
the collaborating authors from the Beth Israel Deaconess Medical Center’s Center for Resuscitation Science Research Group
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1257-x

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