Hydrocortisone administration was associated with improved survival in Japanese patients with cardiac arrest

Abstract

There are few reports on hydrocortisone administration after cardiac arrest, and those that have been published included few subjects. This study aimed to evaluate the effect of hydrocortisone administration on the outcomes of patients who experienced cardiac arrest. We investigated the survival discharge rates and the length of hospital stay from cardiac arrest to discharge, stratified by use of hydrocortisone, using a Japanese health-insurance claims dataset that covers approximately 2% of the Japanese population. The study included the data of 2233 subjects who experienced either in-hospital or out-of-hospital cardiac arrest between January 2005 and May 2014. These patients were divided into two groups, based on the administration of hydrocortisone. We adjusted the baseline characteristics, medical treatment, and drug administration data of the two groups using propensity scores obtained via the inverse probability of treatment weighted method. The hydrocortisone group had a significantly higher survival discharge rate (13/61 [21.1%] vs. 240/2172 [11.0%], adjusted odds ratio: 4.2, 95% CI: 1.60–10.98, p = 0.004). In addition, the administration of hydrocortisone was independent predictor of survival to discharge (hazard ratio: 4.6, p < 0.001). The results demonstrate a correlation between hydrocortisone administration and the high rates of survival to discharge.

Is cardiac arrest an inflammatory state? Adding steroid into ACLS guidelines will save more lives?

“…In another retrospective study conducted in Japan by Nimura et al with both IHCA and OHCA patient data, they also found an improvement in survival rate to hospital discharge and decrease in the length of hospital stay from cardiac arrest to discharge due to hydrocortisone administration during CPR 13 . Both of these studies were performed with a large number of subjects to ensure higher statistical power 11,13 . However, due to the retrospective nature of these studies, they have some limitations, such as: (a) the subjects could not be randomized, and (b) effect of different steroid dosage could not be measured appropriately.…”

“…Due to potential benefits of steroid use, there has been a recent trend in the medical community across the globe to perform clinical research on the effects of administering steroids to patients in cardiac arrest during CPR 10,11,12,13 . Tsai et al conducted a retrospective cohort study with the data from the Taiwan National Health Insurance Research Database to determine the effect of steroids in OHCA outcomes 11 .…”

Steroid use after cardiac arrest is associated with favourable outcomes: a systematic review and meta-analysis

“…The main characteristics of the included studies are shown in Table 1, and the outcome data from each included study are shown in Table 2. We included seven studies 7,8,[12][13][14][15][16] in our analysis. These studies were published between 2001 and 2019.…”

“…Six studies 7,[12][13][14][15][16] examined the association between steroid use and ROSC. Among these six studies, four studies were RCTs and two were cohort studies.…”

“…Four studies 7,8,12,13 reported the association between steroid use and the outcome survival to discharge. When the four groups were pooled together (Figure 3), the effect size analysis (RR 1.67; 95% CI 1.16-2.40, P < 0.005) indicated that steroid use was significantly associated with an increased rate of survival to discharge.…”