دورية أكاديمية
Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial.
العنوان: | Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial. |
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المؤلفون: | 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. |
المصدر: | Critical care (London, England) [Crit Care] 2024 Jan 22; Vol. 28 (1), pp. 28. Date of Electronic Publication: 2024 Jan 22. |
نوع المنشور: | Randomized Controlled Trial; Clinical Trial, Phase II; Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9801902 Publication Model: Electronic Cited Medium: Internet ISSN: 1466-609X (Electronic) Linking ISSN: 13648535 NLM ISO Abbreviation: Crit Care Subsets: MEDLINE |
أسماء مطبوعة: | Publication: London, UK : BioMed Central Ltd Original Publication: London : Current Science Ltd, c1997- |
مواضيع طبية MeSH: | Out-of-Hospital Cardiac Arrest*/complications , Out-of-Hospital Cardiac Arrest*/drug therapy , Emergency Medical Services*, Humans ; Glucocorticoids/pharmacology ; Glucocorticoids/therapeutic use ; Coma/drug therapy ; Hemodynamics ; Norepinephrine/therapeutic use |
مستخلص: | 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).) |
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معلومات مُعتمدة: | E-22652-04 Research Foundation of Rigshospitalet; NNF20OC0064043 Novo Nordisk Fonden |
فهرسة مساهمة: | Keywords: Hemodynamics; Inflammation; Intensive cardiovascular care; Out-of-hospital cardiac arrest; Post-cardiac arrest syndrome; Prehospital intervention; Vasopressor |
سلسلة جزيئية: | ClinicalTrials.gov NCT04624776 |
المشرفين على المادة: | 0 (Glucocorticoids) X4W3ENH1CV (Norepinephrine) |
تواريخ الأحداث: | Date Created: 20240123 Date Completed: 20240124 Latest Revision: 20240404 |
رمز التحديث: | 20240405 |
مُعرف محوري في PubMed: | PMC10801994 |
DOI: | 10.1186/s13054-024-04808-3 |
PMID: | 38254130 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1466-609X |
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DOI: | 10.1186/s13054-024-04808-3 |