Resuscitation Plus (Jun 2022)

Physiologic effects of stress dose corticosteroids in in-hospital cardiac arrest (CORTICA): A randomized clinical trial

  • Spyros D. Mentzelopoulos,
  • Evanthia Pappa,
  • Sotirios Malachias,
  • Charikleia S. Vrettou,
  • Achilleas Giannopoulos,
  • George Karlis,
  • George Adamos,
  • Ioannis Pantazopoulos,
  • Aikaterini Megalou,
  • Zafeiris Louvaris,
  • Vassiliki Karavana,
  • Epameinondas Aggelopoulos,
  • Gerasimos Agaliotis,
  • Marielen Papadaki,
  • Aggeliki Baladima,
  • Ismini Lasithiotaki,
  • Fotini Lagiou,
  • Prodromos Temperikidis,
  • Aggeliki Louka,
  • Andreas Asimakos,
  • Marios Kougias,
  • Demosthenes Makris,
  • Epameinondas Zakynthinos,
  • Maria Xintara,
  • Maria-Eirini Papadonta,
  • Aikaterini Koutsothymiou,
  • Spyros G. Zakynthinos,
  • Eleni Ischaki

Journal volume & issue
Vol. 10
p. 100252

Abstract

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Aim: Postresuscitation hemodynamics are associated with hospital mortality/functional outcome. We sought to determine whether low-dose steroids started during and continued after cardiopulmonary resuscitation (CPR) affect postresuscitation hemodynamics and other physiological variables in vasopressor-requiring, in-hospital cardiac arrest. Methods: We conducted a two-center, randomized, double-blind trial of patients with adrenaline (epinephrine)-requiring cardiac arrest. Patients were randomized to receive either methylprednisolone 40 mg (steroids group) or normal saline-placebo (control group) during the first CPR cycle post-enrollment. Postresuscitation shock was treated with hydrocortisone 240 mg daily for 7 days maximum and gradual taper (steroids group), or saline-placebo (control group). Primary outcomes were arterial pressure and central-venous oxygen saturation (ScvO2) within 72 hours post-ROSC. Results: Eighty nine of 98 controls and 80 of 86 steroids group patients with ROSC were treated as randomized. Primary outcome data were collected from 100 patients with ROSC (control, n = 54; steroids, n = 46). In intention-to-treat mixed-model analyses, there was no significant effect of group on arterial pressure, marginal mean (95% confidence interval) for mean arterial pressure, steroids vs. control: 74 (68–80) vs. 72 (66–79) mmHg] and ScvO2 [71 (68–75)% vs. 69 (65–73)%], cardiac index [2.8 (2.5–3.1) vs. 2.9 (2.5–3.2) L/min/m2], and serum cytokine concentrations [e.g. interleukin-6, 89.1 (42.8–133.9) vs. 75.7 (52.1–152.3) pg/mL] determined within 72 hours post-ROSC (P = 0.12–0.86). There was no between-group difference in body temperature, echocardiographic variables, prefrontal blood flow index/cerebral autoregulation, organ failure-free days, and hazard for poor in-hospital/functional outcome, and adverse events (P = 0.08–>0.99). Conclusions: Our results do not support the use of low-dose corticosteroids in in-hospital cardiac arrest.Trial Registration: ClinicalTrials.gov number: NCT02790788 (https://www.clinicaltrials.gov).

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