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

doi:10.1016/j.resplu.2022.100252

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

Resusc Plus. 2022 May 26:10:100252. doi: 10.1016/j.resplu.2022.100252. eCollection 2022 Jun.

Authors

Spyros D Mentzelopoulos¹, Evanthia Pappa¹, Sotirios Malachias¹, Charikleia S Vrettou¹, Achilleas Giannopoulos¹, George Karlis¹, George Adamos¹, Ioannis Pantazopoulos¹, Aikaterini Megalou¹, Zafeiris Louvaris^{2

3}, Vassiliki Karavana¹, Epameinondas Aggelopoulos¹, Gerasimos Agaliotis¹, Marielen Papadaki¹, Aggeliki Baladima¹, Ismini Lasithiotaki⁴, Fotini Lagiou¹, Prodromos Temperikidis¹, Aggeliki Louka⁴, Andreas Asimakos¹, Marios Kougias¹, Demosthenes Makris⁵, Epameinondas Zakynthinos⁵, Maria Xintara⁵, Maria-Eirini Papadonta⁶, Aikaterini Koutsothymiou⁶, Spyros G Zakynthinos¹, Eleni Ischaki¹

Affiliations

¹ First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, Athens, Greece.
² Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Belgium.
³ University Hospitals Leuven, Department of Intensive Care Medicine, Leuven, Belgium.
⁴ Department of Anesthesiology, Evaggelismos General Hospital, Athens, Greece.
⁵ Department of Intensive Care Medicine, University of Thessaly Medical School, Larissa, Greece.
⁶ Department of Anesthesiology, University of Thessaly Medical School, Larissa, Greece.

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 ).

Keywords: Heart Arrest; Hemodynamics; Hydrocortisone; Methylprednisolone; Post-cardiac arrest syndrome.

Associated data

ClinicalTrials.gov/NCT02790788