The following is a summary of “Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial,” published in the January 2024 issue of Critical Care by Obling et al.

Glucocorticoids hold promise in mitigating post-out-of-hospital cardiac arrest (OHCA)  inflammation, potentially reducing vasopressor reliance and improving organ function.

Researchers conducted a retrospective study to evaluate the hemodynamic impacts of prehospital high-dose glucocorticoids in resuscitated comatose OHCA patients.

They conducted an STEROHCA phase 2 trial to investigate prehospital methylprednisolone’s impact (250 mg) versus placebo post-resuscitated OHCA. The focus was on comatose survivors at ICU admission, assessing primary outcomes as cumulative norepinephrine use (mcg/kg/min) within 48 h. Secondary outcomes included hemodynamic parameters (MAP, heart rate, vasoactive-inotropic score (VIS)/MAP-ratio) and cardiac function via pulmonary artery catheter measurements. Linear mixed-model analyses compared treatment groups across follow-up times.

The result showed 114 comatose OHCA patients (glucocorticoid: n = 56, placebo: n = 58); no differences in outcomes were observed at ICU admission. From ICU admission up to 48 h post-admission, the glucocorticoid group showed lower norepinephrine use (mean difference: -0.04 mcg/kg/min, 95% CI: -0.07 to -0.01, P=0.02). At 12–24 h post-admission, the glucocorticoid group exhibited higher MAP (mean differences: 6–7 mmHg, 95% CIs: 1 to 12), lower VIS (mean differences: -4.2 to -3.8, 95% CIs: -8.1 to 0.3), and lower VIS/MAP ratio (mean differences: -0.10 to -0.07, 95% CIs: -0.16 to -0.01), with no significant differences in heart rate (mean differences: -4 to -3, 95% CIs: -11 to 3). These group differences persisted 30–48 h post-admission, albeit to a lesser extent, and increased statistical uncertainty. No disparities were found in pulmonary artery catheter measurements between groups.

Investigators concluded that high-dose steroids in prehospital OHCA care potentially reduce post-resuscitation norepinephrine needs. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04808-3