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Postarrest Steroid Use May Improve Outcomes of Cardiac Arrest Survivors

Tsai, Min-Shan, MD, PhD1,2; Chuang, Po-Ya, MHA3; Huang, Chien-Hua, MD, PhD1; Tang, Chao-Hsiun, PhD3; Yu, Ping-Hsun, MD4; Chang, Wei-Tien, MD, PhD1; Chen, Wen-Jone, MD, PhD1,5

doi: 10.1097/CCM.0000000000003468
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Objectives: To evaluate the ramifications of steroid use during postarrest care.

Design: Retrospective observational population-based study enrolled patients during years 2004–2011 with 1-year follow-up.

Setting: Taiwan National Health Insurance Research Database.

Patients: Adult nontraumatic cardiac arrest patients in the emergency department, who survived to admission.

Interventions: These patients were classified into the steroid and nonsteroid groups based on whether steroid was used or not during hospitalization. A propensity score was used to match patient underlying characteristics, steroid use prior to cardiac arrest, the vasopressors, and shockable rhythm during cardiopulmonary resuscitation, hospital level, and socioeconomic status.

Measurements and Main Results: There were 5,445 patients in each group after propensity score matching. A total of 4,119 patients (75.65%) in the steroid group died during hospitalization, as compared with 4,403 patients (80.86%) in the nonsteroid group (adjusted hazard ratio, 0.74; 95% CI, 0.70–0.77; p < 0.0001). The mortality rate at 1 year was significantly lower in the steroid group than in the nonsteroid group (83.54% vs 87.77%; adjusted hazard ratio, 0.73; 95% CI, 0.70–0.76; p < 0.0001). Steroid use during hospitalization was associated with survival to discharge, regardless of age, gender, underlying diseases (diabetes mellitus, chronic obstructive pulmonary disease, asthma), shockable rhythm, and steroid use prior to cardiac arrest.

Conclusions: In this retrospective observational study, postarrest steroid use was associated with better survival to hospital discharge and 1-year survival.

1Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan.

2Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.

3School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.

4Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan.

5Division of Cardiology, Department of Internal Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan.

This study was performed in National University Hospital.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by a research grant from the National Taiwan University Hospital, grant number 104-S2755.

Dr. Chuang received funding from National Taiwan University Hospital. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: wjchen1955@ntu.edu.tw

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