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Efficacy and safety of corticosteroid therapy in patients with cardiac arrest: a systematic review of randomised controlled trials

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Abstract

Purposes

The role of corticosteroid therapy in patients with cardiac arrest (CA) is uncertain. We aimed to evaluate the efficacy and safety of corticosteroid therapy in CA patients.

Methods

Randomised controlled trials were identified using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure and the Chinese Biomedical Literature Database. The primary outcome was overall survival. Secondary outcomes were positive neurological status and probability of sustained restoration of spontaneous circulation (ROSC). Complications were infection and bleeding. Given the significant heterogeneity across previous studies, combining the data using meta-analysis was deemed not appropriate.

Results

Five studies (551 patients) met the criteria. Two studies of co-intervention therapy (corticosteroid, vasopressin and epinephrine protocol) found that this approach could benefit in-hospital CA patient survival rates at hospital discharge, improve neurological function at hospital discharge and yield sustained ROSC rate. However, further two studies failed to demonstrate that corticosteroid therapy alone could improve survival and neurological outcomes among CA patients. Additionally, corticosteroid therapy did not increase the risk of infection and bleeding.

Conclusions

Due to the inherent limitations of the studies in this review, we have not been able to reach definitive conclusions. Larger-scale and better-designed studies are therefore recommended, to further evaluate the potential and rational use of corticosteroid therapy in CA patients.

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References

  1. Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, Cabanas JG, Cone DC, Diercks DB, Foster J(J), Meeks RA, Travers AH, Welsford M (2015) Part 4: systems of care and continuous quality improvement: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132:S397–S413

    Article  Google Scholar 

  2. Donnino MW, Andersen LW, Berg KM et al (2015) Temperature management after cardiac arrest: an advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation 132:2448–2456

    Article  CAS  Google Scholar 

  3. Madder RD, Reynolds JC (2018) Multidisciplinary management of the post-cardiac arrest patient. Cardiol Clin 36:85–101

    Article  Google Scholar 

  4. Myat A, Song KJ, Rea T (2018) Out-of-hospital cardiac arrest: current concepts. Lancet 391:970–979

    Article  Google Scholar 

  5. Schultz CH, Rivers EP, Feldkamp CS et al (1993) A characterization of hypothalamic-pituitary adrenal axis function during and after human cardiac arrest. Crit Care Med 21:1339–1347

    Article  CAS  Google Scholar 

  6. Ito T, Saitoh D, Takasu A, Kiyozumi T, Sakamoto T, Okada Y (2004) Serum cortisol as a predictive marker of the outcome in patients resuscitated after cardiopulmonary arrest. Resuscitation 62:55–60

    Article  CAS  Google Scholar 

  7. Tavakoli N, Bidari A, Shams Vahdati S (2012) Serum cortisol levels as a predictor of neurologic survival in successfully resuscitated victims of cardiopulmonary arrest. J Cardiovasc Thorac Res 4:107–111

    PubMed  PubMed Central  Google Scholar 

  8. White BC, Petinga TJ, Hoehner PJ, Wilson RF (1979) Incidence, etiology and outcome of pulseless idioventricular rhythm treated with dexamethasone during advanced CPR. JACEP 8:188–193

    Article  CAS  Google Scholar 

  9. Schwitzer KW (1983) Dexamethasone therapy in bradyasystolic prehospital cardiac arrest, abstract. Ann Emerg Med 12:252

    Google Scholar 

  10. Tsai MS, Huang CH, Chang WT, Chen WJ, Hsu CY, Hsieh CC, Yang CW, Chiang WC, Huei-Ming Ma M, Chen SC (2007) The effect of hydrocortisone on the outcome of out-of-hospital cardiac arrest patients: a pilot study. Am J Emerg Med 25:318–325

    Article  Google Scholar 

  11. Jastremski M, Sutton-Tyrrell K, Vaagenes P, Abramson N, Heiselman D, Safar P (1989) Glucocorticoid treatment does not improve neurological recovery following cardiac arrest. JAMA 262:3427–3430

    Article  CAS  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med 3:e123–e130

    PubMed  PubMed Central  Google Scholar 

  13. Mentzelopoulos SD, Zakynthinos SG, Tzoufi M, Katsios N, Papastylianou A, Gkisioti S, Stathopoulos A, Kollintza A, Stamataki E, Roussos C (2009) Vasopressin, epinephrine, and corticosteroids for in-hospital cardiac arrest. Arch Intern Med 169:15–24

    Article  CAS  Google Scholar 

  14. Mentzelopoulos SD, Malachias S, Chamos C, Konstantopoulos D, Ntaidou T, Papastylianou A, Kolliantzaki I, Theodoridi M, Ischaki H, Makris D, Zakynthinos E, Zintzaras E, Sourlas S, Aloizos S, Zakynthinos SG (2013) Vasopressin, steroids, and epinephrine and neurologically favorable survival after in-hospital cardiac arrest. JAMA 310:270–279

    Article  Google Scholar 

  15. The Brain Resuscitation Clinical Trial II Study Group (1991) A randomized clinical trial of calcium entry blocker administration to comatose survivors of cardiac arrest: design, methods, and patient characteristics. Control Clin Trials 12:525–545

    Article  Google Scholar 

  16. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  Google Scholar 

  17. Bolvardi E, Seyedi E, Seyedi M et al (2016) Studying the influence of epinephrine mixed with prednisolone on the neurologic side effects after recovery in patients suffering from cardiopulmonary arrest. Biomed Pharmacol J 9:209–214

    Article  Google Scholar 

  18. Donnino MW, Andersen LW, Berg KM et al (2016) Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial. Crit Care 20:1–8

    Article  Google Scholar 

  19. Paris PM, Stewart RD, Deggler F (1984) Prehospital use of dexamethasone in pulseless idioventricular rhythm. Ann Emerg Med 13:100810

    Google Scholar 

  20. Liu B, Zhang Q, Li C (2020) Steroid use after cardiac arrest is associated with favourable outcomes: a systematic review and meta-analysis. J Int Med Res 48:300060520921670

    PubMed  Google Scholar 

  21. Tsai MS, Chuang PY, Yu PH, Huang CH, Tang CH, Chang WT, Chen WJ (2016) Glucocorticoid use during cardiopulmonary resuscitation may be beneficial for cardiac arrest. Int J Cardiol 222:629–635

    Article  Google Scholar 

  22. Kornberger E, Prengel AW, Krismer A, Schwarz B, Wenzel V, Lindner KH, Mair P (2000) Vasopressin-mediated adrenocorticotropin release increases plasma cortisol concentrations during cardiopulmonary resuscitation. Crit Care Med 28:3517–3521

    Article  CAS  Google Scholar 

  23. Krismer AC, Wenzel V, Voelckel WG, Stadlbauer KH, Wagner-Berger H, Schaefer A, Lindner KH (2003) Effects of vasopressin on adrenal gland regional perfusion during experimental cardiopulmonary resuscitation. Resuscitation 56:223–228

    Article  CAS  Google Scholar 

  24. Smithline H, Rivers E, Appleton T, Nowak R (1993) Corticosteroid supplementation during cardiac arrest in rats. Resuscitation 25:257–264

    Article  CAS  Google Scholar 

  25. Varvarousi G, Stefaniotou A, Varvaroussis D, Xanthos T (2014) Glucocorticoids as an emerging pharmacologic agent for cardiopulmonary resuscitation. Cardiovasc Drugs Ther 28:477–488

    Article  CAS  Google Scholar 

  26. Elmer J, Callaway CW (2017) The brain after cardiac arrest. Semin Neurol 37:19–24

    Article  Google Scholar 

  27. Reis C, Akyol O, Araujo C et al (2017) Pathophysiology and the monitoring methods for cardiac arrest associated brain injury. Int J Mol Sci 18:E129

    Article  Google Scholar 

  28. Adrie C, Laurent I, Monchi M, Cariou A, Dhainaou JF, Spaulding C (2004) Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care 10:208–212

    Article  Google Scholar 

  29. Hékimian G, Baugnon T, Thuong M et al (2004) Cortisol levels and adrenal reserve after successful cardiac arrest resuscitation. Shock 22:116–119

    Article  Google Scholar 

  30. Dixon WG, Abrahamowicz M, Beauchamp ME, Ray DW, Bernatsky S, Suissa S, Sylvestre MP (2012) Immediate and delayed impact of oral glucocorticoid therapy on risk of serious infection in older patients with rheumatoid arthritis: a nested case-control analysis. Ann Rheum Dis 71:1128–1131

    Article  CAS  Google Scholar 

  31. Tseng CL, Chen YT, Huang CJ, Luo JC, Peng YL, Huang DF, Hou MC, Lin HC, Lee FY (2015) Short-term use of glucocorticoids and risk of peptic ulcer bleeding: a nationwide population-based case-crossover study. Aliment Pharmacol Ther 42:599–606

    Article  CAS  Google Scholar 

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Funding

This study was supported by a grant (QRX17124) for Nanjing Medical Science and Technique Development Foundation.

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Authors and Affiliations

  1. Geriatric Department, Zhongda Hospital Southeast University, Nanjing, 210008, China

    Yajie Li & Jun Zhang

  2. Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China

    Nan Cai & Fei He

Authors
  1. Yajie Li
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  2. Jun Zhang
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  3. Nan Cai
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  4. Fei He
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Contributions

(1) FH and YJL contributed to the conception and design of the study; (2) JZ and NC contributed to the data acquisition, data analysis and interpretation; (3) YJL and FH contributed to draft the article; (4) FH contributed to revise it critically for important intellectual content; (5) all authors read and approved the final manuscript to be submitted.

Corresponding authors

Correspondence to Nan Cai or Fei He.

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The authors declare that they have no competing interests.

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Li, Y., Zhang, J., Cai, N. et al. Efficacy and safety of corticosteroid therapy in patients with cardiac arrest: a systematic review of randomised controlled trials. Eur J Clin Pharmacol 76, 1631–1638 (2020). https://doi.org/10.1007/s00228-020-02964-3

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  • DOI: https://doi.org/10.1007/s00228-020-02964-3

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