Hydrocortisone in Patients of Out-of-hospital Cardiac Arrest
Information source: National Taiwan University Hospital
ClinicalTrials.gov processed this data on August 23, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Heart Arrest
Intervention: Hydrocortisone (Drug)
Phase: N/A
Status: Completed
Sponsored by: National Taiwan University Hospital Official(s) and/or principal investigator(s): Wen-Jone Chen, PhD, Study Director, Affiliation: Chiarman of NTUH emergency department
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
Clinical Details
Official title: Hydrocortisone in Patients of Out-of-hospital Cardiac Arrest
Study design: Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Eligibility
Minimum age: 18 Years.
Maximum age: N/A.
Gender(s): Both.
Criteria:
Inclusion Criteria:
- Out-of-hospital cardiac arrest
Exclusion Criteria:
- pregnancy
- younger than 18 years old
- trauma
- concurrent steroid use
- ECMO use in resuscitation
- allergy to steroid
Locations and Contacts
National Taiwan University Hospital, Taipei 100, Taiwan
Additional Information
Starting date: October 2004
Last updated: November 30, 2012
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