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

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Mentzelopoulos S.D., Pappa E., Malachias S., Vrettou C.S., Giannopoulos A., Karlis G., Adamos G., Pantazopoulos I., Megalou A., Louvaris Z., Karavana V., Aggelopoulos E., Agaliotis G., Papadaki M., Baladima A., Lasithiotaki I., Lagiou F., Temperikidis P., Louka A., Asimakos A., Kougias M., Makris D., Zakynthinos E., Xintara M., Papadonta M.-E., Koutsothymiou A., Zakynthinos S.G., Ischaki E.
Date
2022
Language
en
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Abstract
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). © 2022 The Authors
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http://hdl.handle.net/11615/76550
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