Hydrocortisone in Patients of Out-of-hospital Cardiac Arrest
Status:
Completed
Trial end date:
2006-05-01
Target enrollment:
Participant gender:
Summary
Out-of-hospital cardiac arrest (OHCA) is an important issue for the emergency physicians and
co-workers. How to improve the return of spontaneous circulation (ROSC) rate and prognosis of
these patients challenges the emergency team. When encounters stress, the hypothalamus of
human releases corticotropin releasing hormone, which in turn stimulates the pituitary gland
to release ACTH. Then ACTH acts on the adrenal gland to release glucocorticoid to against
stress. Foley PJ et al found the dogs with bilateral adrenalectomy had lower ROSC rate during
resuscitation than those without surgery[1]. Karl H. Linder et al showed OHCA patients had
high serum vasopressin and ACTH level but low serum cortisol level. Besides, the serum
cortisol level had a negative correlation with collapse duration (no CPR duration)[2].
Studies also revealed the successfully resuscitated patients had higher serum ACTH and
cortisol level than non-resuscitated ones[2,3]. In addition, the serum cortisol level was
found to be correlated with short term survival rate and hemodynamic status in resuscitated
OHCA patients[3]. Animal study also showed mice receiving higher dosage of hydrocortisone had
higher ROSC rate and lower epinephrine requirement than those receiving lower dosage of
hydrocortisone or normal saline.
1. Foley PJ, Tacker WA, Wortsman J, Frank S, Cryer PE.;" Plasma catecholamine and serum
cortisol responses to experimental cardiac arrest in dogs."Am J Physiol 1987;253:E283-9
2. Lindner KH, Strohmenger HU, Ensinger H, Hetzel WD, Ahnefeld FW, Georgieff M.;" Stress
hormone response during and after cardiopulmonary resuscitation."Anesthesiology
1992;77:662-8
3. Schultz CH, Rivers EP, Feldkamp CS, Goad EG, Smithline HA, Martin GB, Fath JJ, Wortsman
J, Nowak RM.;"A characterization of hypothalamic-pituitary-adrenal axis function during
and after human cardiac arrest."Crit Care Med 1993;21:1339-47
4. Smithline H, Rivers E, Appleton T, Nowak R.;"Corticosteroid supplementation during
cardiac arrest in rats."Resuscitation 1993;25:257-64