Hydrocortisone in Patients of Out-of-hospital Cardiac Arrest

Study Overview
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Brief Summary
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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. <Reference> 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 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 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 Smithline H, Rivers E, Appleton T, Nowak R.;Corticosteroid supplementation during cardiac arrest in rats.Resuscitation 1993;25:257-64

Official Title
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Hydrocortisone in Patients of Out-of-hospital Cardiac Arrest

Conditions
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Heart Arrest

Intervention / Treatment
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* Drug: Hydrocortisone


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: Hydrocortisone|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |