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Fig. 1
Flow diagram of enrolled patients. ECMO, extracorporeal membrane oxygenation.
Fig. 2
(A-C) Return of spontaneous circulation comparison in terms of different timings of drug application during resuscitation. Collapse-to-drug interval indicates duration from collapse to hydrocortisone application; arrival-to-drug interval, duration from emergency department arrival to the use of the study drugs.
Abstract
Objective
Several studies have disclosed the importance of serum adrenocorticotropic hormone and cortisol levels in resuscitation. The objective of this study was to observe the effect of hydrocortisone on the outcome of out-of-hospital cardiac arrest (OHCA) patients.
Design
Prospective, nonrandomized, open-labeled clinical trial.
Setting
Emergency department (ED) of National Taiwan University Hospital.
Patients and Participants
Ninety-seven nontraumatic adult OHCA victims.
Interventions
Serum adrenocorticotropic hormone and total cortisol levels were examined in all patients. The hydrocortisone group (n = 36) received 100 mg intravenous hydrocortisone during resuscitation, and the nonhydrocortisone group (n = 61) received 0.9% saline as placebo.
Measurements and Results
Comparison of return of the spontaneous circulation (ROSC) rates between the 2 groups was analyzed. The hydrocortisone group had a significantly higher ROSC rate than the nonhydrocortisone group (61% vs 39%, P = .038). Hydrocortisone administration within 6 minutes after ED arrival led to an increased ROSC rate (90% vs 50%, P = .045). The hydrocortisone and nonhydrocortisone groups did not differ in the development of electrolyte disturbances, gastrointestinal tract bleeding, or infection during early postresuscitation period (gastrointestinal bleeding: 41% vs 46%, P = .89; infection: 50% vs 75%, P = .335). There was no significant difference between the hydrocortisone and nonhydrocortisone groups in terms of 1- and 7-day survival and hospital discharge rates.
Conclusions
Hydrocortisone treatment during resuscitation, particularly when administrated within 6 minutes of ED arrival, may be associated with an improved ROSC rate in OHCA patients.
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This study was supported in part by a grant form the National Taiwan University Hospital (NTUH 94S161), Taipei, Taiwan.
