Hormonal responses upon return of spontaneous circulation after cardiac arrest: a retrospective cohort study

Abstract

IntroductionCardiac arrest is often fatal and can be extremely stressful to patients, even if spontaneous rhythm is returned. The purpose of this study was to analyze the hormonal response after return of spontaneous circulation (ROSC).MethodsThis is a retrospective review of the chart and laboratory findings in a single medical facility. The patients admitted to the intensive care unit after successful resuscitation after out-of-hospital cardiac arrest were retrospectively identified and evaluated. Patients with hormonal diseases, patients who received cortisol treatment, those experiencing trauma, and pregnant women were excluded. Serum cortisol, adrenocorticotropic hormone (ACTH), and anti-diuretic hormone (ADH (vasopressin)) were analyzed and a corticotropin-stimulation test was performed. Mortality at one week and one month after admission, and neurologic outcome (cerebral performance category (CPC)) one month after admission were evaluated.ResultsA total of 117 patients, including 84 males (71.8%), were evaluated in this study. One week and one month after admission, 87 (74.4%) and 65 patients (55.6%) survived, respectively. Relative adrenal insufficiency, and higher plasma ACTH and ADH levels were associated with shock-related mortality (P = 0.046, 0.005, and 0.037, respectively), and ACTH and ADH levels were also associated with late mortality (P = 0.002 and 0.004, respectively). Patients with relative adrenal insufficiency, ACTH ≧5 pg/mL, and ADH ≧30 pg/mL, had a two-fold increased risk of a poor outcome (shock-related mortality): (odds ratio (OR), 2.601 and 95% confidence interval (CI), 1.015 to 6.664; OR, 2.759 and 95% CI, 1.060 to 7.185; OR, 2.576 and 95% CI, 1.051 to 6.313, respectively). Thirty-five patients (29.9%) had a good CPC (1 to 2), and 82 patients (70.1%) had a bad CPC (3 to 5). Age ≧50 years and an ADH ≧30 pg/mL were associated with a bad CPC (OR, 4.564 and 95% CI, 1.794 to 11.612; OR, 6.568 and 95% CI, 1.918 to 22.483, respectively).ConclusionsThe patients with relative adrenal insufficiency and higher blood levels of ACTH and ADH upon ROSC after cardiac arrest had a poor outcome. The effectiveness of administration of cortisol and ADH to patients upon ROSC after cardiac arrest is uncertain and additional studies are needed.

Blood levels of copeptin on admission predict outcomes in out-of-hospital cardiac arrest survivors treated with therapeutic hypothermia

“…Moreover, Jarai and colleagues reported that preoperative copeptin concentrations predict postoperative outcome after major vascular surgery [16]. Our observations are also in good agreement with the study by Kim and colleagues, in which they described that cardiac arrest survivors with relative adrenal insufficiency, higher blood levels of adrenocorticotropic hormone and vasopressin have poor outcomes [17]. …”

CT-proAVP (copeptin), MR-proANP and Peroxiredoxin 4 after cardiac arrest: release profiles and correlation to outcome

“…Previously, high vasopressin concentrations have been measured during advanced cardiopulmonary resuscitation in patients successfully resuscitated after OHCA, a finding implicating impaired neuroendocrine stress response in non‐survivors. Kim and co‐workers, on the other hand, showed that high vasopressin concentrations in patients with ROSC were associated with increased mortality at 1 month . In a recent publication, a correlation between high CT‐proAVP concentration at admission to the ICU after OHCA and poor outcome was highlighted .…”

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

“…There is evidence of dysregulation of the hypothalamic-pituitary-adrenal axis and concurrent adrenal insufficiency along with increase systemic inflammation as assessed by serum interleukin (IL)-6 levels in comatose survivors of out-of-hospital cardiac arrest (OHCA) in the early post-resuscitation phase 2,3 Furthermore, cytokines (i.e. IL-1, IL-6, IL-8 and tumor necrosis factor-alpha), synergistically depress myocardial contractile function and may thus contribute to post-resuscitation myocardial dysfunction 4,5 .…”

“…IL-1, IL-6, IL-8 and tumor necrosis factor-alpha), synergistically depress myocardial contractile function and may thus contribute to post-resuscitation myocardial dysfunction 4,5 . Lower levels of steroids and higher levels of IL-6 following return of spontaneous circulation (ROSC) have been associated with worse outcomes 2,3,5 . Vaahersalo et al reported that high IL-6 levels on hospital admission following OHCA are associated with post-resuscitation organ dysfunction and independently predict poor neurologic outcome at 12 months 6 Usually a stressful physiological event causes blood cortisol level to increase.…”