TY - JOUR
T1 - Glucocorticoid use during cardiopulmonary resuscitation may be beneficial for cardiac arrest
AU - Tsai, Min Shan
AU - Chuang, Po Ya
AU - Yu, Ping Hsun
AU - Huang, Chien Hua
AU - Tang, Chao Hsiun
AU - Chang, Wei Tien
AU - Chen, Wen Jone
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background Various studies have indicated that glucocorticoid supplementation during cardiopulmonary resuscitation (CPR), in conjunction with vasopressors, may improve outcomes in instances of cardiac arrest. However, further population-based analysis is warranted with respect to resuscitative and long-term survival benefits conferred by administering glucocorticoids in this setting. Methods A total of 145,644 adult patients who experienced non-traumatic, cardiac arrest occurred at emergency room during years 2004–2011 were selected for study from the Taiwan National Health Insurance Research database. These patients were grouped as steroid and non-steroid recipients during CPR, and group members were matched in terms of patient characteristics, including presenting complaint, prior steroid use, resuscitative drugs and shocks delivered, treatment setting (medical center or not), socioeconomic status, and year that cardiac arrest occurred, through propensity scoring. Logistic regression analysis was performed to determine the impact of steroid usage on survival to admission, survival to discharge, and 1-year survival. Results Compared with matched non-steroid group members (n = 8628), patients given steroid (n = 2876) displayed significantly higher rates of survival to admission (38.32% vs 18.67%; adjusted OR = 2.97, 95% CI 2.69–3.29; p < 0.0001), survival to discharge (14.50% vs 5.61%; adjusted OR = 1.71, 95% CI 1.42–2.05; p < 0.0001), and 1-year overall survival (10.81% vs 4.74%; adjusted OR = 1.48, 95% CI 1.22–1.79; p < 0.0001). Steroid use proved more beneficial in patients with COPD or asthma and in the absence of shockable rhythm during CPR. Conclusion Glucocorticoid use during CPR is associated with improved survival-to-admission, survival-to-discharge, and 1-year survival rates.
AB - Background Various studies have indicated that glucocorticoid supplementation during cardiopulmonary resuscitation (CPR), in conjunction with vasopressors, may improve outcomes in instances of cardiac arrest. However, further population-based analysis is warranted with respect to resuscitative and long-term survival benefits conferred by administering glucocorticoids in this setting. Methods A total of 145,644 adult patients who experienced non-traumatic, cardiac arrest occurred at emergency room during years 2004–2011 were selected for study from the Taiwan National Health Insurance Research database. These patients were grouped as steroid and non-steroid recipients during CPR, and group members were matched in terms of patient characteristics, including presenting complaint, prior steroid use, resuscitative drugs and shocks delivered, treatment setting (medical center or not), socioeconomic status, and year that cardiac arrest occurred, through propensity scoring. Logistic regression analysis was performed to determine the impact of steroid usage on survival to admission, survival to discharge, and 1-year survival. Results Compared with matched non-steroid group members (n = 8628), patients given steroid (n = 2876) displayed significantly higher rates of survival to admission (38.32% vs 18.67%; adjusted OR = 2.97, 95% CI 2.69–3.29; p < 0.0001), survival to discharge (14.50% vs 5.61%; adjusted OR = 1.71, 95% CI 1.42–2.05; p < 0.0001), and 1-year overall survival (10.81% vs 4.74%; adjusted OR = 1.48, 95% CI 1.22–1.79; p < 0.0001). Steroid use proved more beneficial in patients with COPD or asthma and in the absence of shockable rhythm during CPR. Conclusion Glucocorticoid use during CPR is associated with improved survival-to-admission, survival-to-discharge, and 1-year survival rates.
KW - Cardiac arrest
KW - Cardiopulmonary resuscitation
KW - Glucocorticoid
KW - Propensity score
KW - Survival
KW - Taiwan National Health Insurance Research database
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U2 - 10.1016/j.ijcard.2016.08.017
DO - 10.1016/j.ijcard.2016.08.017
M3 - Article
C2 - 27517652
AN - SCOPUS:84982855430
SN - 0167-5273
VL - 222
SP - 629
EP - 635
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -