Monday, August 1, 2016

Early stress-dose steroids in cardiac arrest

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Mentzelopoulos S et al. Critical Care 2016; 20:211 - DOI: 10.1186/s13054-016-1384-4 - Published: 20 July 2016
..:"Early post-resuscitation hemodynamics of VSE patients could be partly attributable to the steroids-vasopressin combination during cardiopulmonary resuscitation (CPR). However, a previously postulated major CPR-VSE effect, i.e., shorter advanced life support duration, possibly leading to attenuated post-resuscitation cardiovascular dysfunction was not clear in the current subgroup analysis (Table 1). Hence, according to the short (i.e., 24 min) half-life of vasopressin, we propose that the more frequent day 1 MAP >80 mmHg was largely due to a post-ROSC steroid-induced augmentation of vascular responsiveness to vasopressors. A mediation analysis of VSE outcome benefit through day 1 MAP is warranted. Analysis of day 1 MAP data from the study by Donnino et al. might causally link between-RCT differences in corticosteroid timing with differences in survival/neurological outcome results.
Post-resuscitation disease is a “sepsis-like” syndrome. In sepsis, acute kidney injury severity is associated with mortality and elevated interleukin (IL)-6. Furthermore, high post-ROSC IL-6 is associated with organ dysfunction and poor long-term outcomes. Notably, post-resuscitation hydrocortisone has been associated with reduced IL-6 levels, and VSE patients versus controls had more renal failure-free days.
Conclusively, available evidence prompts toward further evaluation of early, stress-dose steroids in cardiac arrest."