Inflammatory response after out‐of‐hospital cardiac arrest—Impact on outcome and organ failure development

Seppa, Andre; Skrifvars, Markus B.; Pekkarinen, Pirkka T.

doi:10.1111/aas.14291

Cited by 8 publications

(2 citation statements)

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“…Myocardial ischemia during cardiac arrest leads to impaired contractility, which is then aggravated through ischemic/reperfusion injury due to an excessive cascade of pro-inflammatory cytokines and elevated circulating catecholamines [ 9 ]. Systemic inflammation contributes to myocardial injury and further to multiorgan dysfunction complicating the clinical status of post-cardiac arrest patients [ 28 , 29 ]. In recent years, two animal studies have found that high-dose glucocorticoid treatment reduced myocardial dysfunction and improved microcirculation in the post-resuscitation phase [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial

Obling,

Beske,

Meyer

et al. 2024

Crit Care

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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. Graphic Abstract

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Section: Discussionmentioning

confidence: 99%

Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial

Obling,

Beske,

Meyer

et al. 2024

Crit Care

View full text Add to dashboard Cite

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“… 15 , 17 , 18 , 19 , 38 Further, IFABP has been convincingly associated with mortality after cardiac arrest, while IL-6 are among the few inflammatory biomarkers which are associated with poor outcome after adjustment for confounding factors. 9 , 39 , 40 , 41 , 42 , 43 , 44 Importantly, IFABP and inflammatory biomarkers could merely increase in parallel with the degree of whole-body ischaemia. 20 , 21 …”

Section: Discussionmentioning

confidence: 99%