Serum cortisol as a predictive marker of the outcome in patients resuscitated after cardiopulmonary arrest

Glucocorticoids as an Emerging Pharmacologic Agent for Cardiopulmonary Resuscitation

“…The homeostasis of the neuroendocrine system is damaged, because cortisol is not secreted in response to ACTH, thus resulting in a low concentration of serum cortisol and in high concentrations of the plasma ACTH and ADH. Studies have shown that cortisol levels are relatively low during and after CPR, indicating a dysfunction of the adrenal gland [6, 7]. Schultz et al pointed out that there was no serum cortisol response at either 6 or 24 h after resuscitation, indicating that the adrenal gland was refractory to ACTH [6].…”

“…Schultz et al pointed out that there was no serum cortisol response at either 6 or 24 h after resuscitation, indicating that the adrenal gland was refractory to ACTH [6]. The low response of the adrenal glands to ACTH in non-survivors indicates a greater suppression of the adrenal function in comparison to the one observed in survivors [7]. …”

“…Kim et al reported in a prospective study that relative adrenal insufficiency may be associated with increased mortality rate in patients with ROSC [26]. Two other studies reported that low cortisol levels caused organ damage by reperfusion injury [7, 29]. Hekimian et al reported that patients who die of early refractory shock after CPR may have an inadequate adrenal response [76].…”

“…Emerging evidence demonstrate that CA could cause CA-related adrenal insufficiency that is highly correlated with poor outcome and increased mortality [5–7]. Moreover, adrenal insufficiency may manifest as an inability to increase cortisol secretion during and after CPR [6, 8].…”

Emerging pharmaceutical therapies in cardiopulmonary resuscitation and post-resuscitation syndrome

“…This relative adrenal insufficiency is common, occurring in 43-52% of patients post-ROSC, but often remains undetected. 12 Most studies suggest that serum cortisol levels are higher in survivors of CA, 13 and patients who fail to increase cortisol levels often die due to refractory post-CA shock. There are, however, reports that ACTH and free cortisol levels are higher in non-survivors of CA, indicating that persistent hypotension and fatal cerebral damage may cause greater activation of the pituitary-adrenal axis.…”