Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial.

Autor: Obling LER; Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark. laust.emil.roelsgaard.obling.01@regionh.dk., Beske RP; Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark., Meyer MAS; Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark., Grand J; Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark., Wiberg S; Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark.; Department of Thoracic Anesthesiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Mohr T; Department of Intensive Care, Herlev-Gentofte Hospital - Copenhagen University Hospital, Copenhagen, Denmark., Damm-Hejmdal A; Copenhagen Emergency Services, Capital Region of Denmark, Copenhagen, Denmark., Forman JL; Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark., Frikke-Schmidt R; Department of Clinical Biochemistry, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Folke F; Copenhagen Emergency Services, Capital Region of Denmark, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Cardiology, Herlev-Gentofte Hospital - Copenhagen University Hospital, Copenhagen, Denmark., Møller JE; Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Cardiology, Odense University Hospital, Odense, Denmark., Kjaergaard J; Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Hassager C; Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, OE, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Jan 22; Vol. 28 (1), pp. 28. Date of Electronic Publication: 2024 Jan 22.
DOI: 10.1186/s13054-024-04808-3
Abstrakt: Background: Following resuscitated out-of-hospital cardiac arrest (OHCA), inflammatory markers are significantly elevated and associated with hemodynamic instability and organ dysfunction. Vasopressor support is recommended to maintain a mean arterial pressure (MAP) above 65 mmHg. Glucocorticoids have anti-inflammatory effects and may lower the need for vasopressors. This study aimed to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients.
Methods: The STEROHCA trial was a randomized, placebo-controlled, phase 2 trial comparing one prehospital injection of methylprednisolone 250 mg with placebo immediately after resuscitated OHCA. In this sub-study, we included patients who remained comatose at admission and survived until intensive care unit (ICU) admission. The primary outcome was cumulated norepinephrine use from ICU admission until 48 h reported as mcg/kg/min. Secondary outcomes included hemodynamic status characterized by MAP, heart rate, vasoactive-inotropic score (VIS), and the VIS/MAP-ratio as well as cardiac function assessed by pulmonary artery catheter measurements. Linear mixed-model analyses were performed to evaluate mean differences between treatment groups at all follow-up times.
Results: A total of 114 comatose OHCA patients were included (glucocorticoid: n = 56, placebo: n = 58) in the sub-study. There were no differences in outcomes at ICU admission. From the time of ICU admission up to 48 h post-admission, patients in the glucocorticoid group cumulated a lower norepinephrine use (mean difference - 0.04 mcg/kg/min, 95% CI - 0.07 to - 0.01, p = 0.02). Moreover, after 12-24 h post-admission, the glucocorticoid group demonstrated a higher MAP with mean differences ranging from 6 to 7 mmHg (95% CIs from 1 to 12), a lower VIS (mean differences from - 4.2 to - 3.8, 95% CIs from - 8.1 to 0.3), and a lower VIS/MAP ratio (mean differences from - 0.10 to - 0.07, 95% CIs from - 0.16 to - 0.01), while there were no major differences in heart rate (mean differences from - 4 to - 3, 95% CIs from - 11 to 3). These treatment differences between groups were also present 30-48 h post-admission but to a smaller extent and with increased statistical uncertainty. No differences were found in pulmonary artery catheter measurements between groups.
Conclusions: Prehospital treatment with high-dose glucocorticoid was associated with reduced norepinephrine use in resuscitated OHCA patients.
Trial Registration: EudraCT number: 2020-000855-11; submitted March 30, 2020. URL: https://www.
Clinicaltrials: gov ; Unique Identifier: NCT04624776.
(© 2024. The Author(s).)
Databáze: MEDLINE
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