Corticosteroid use with extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A nationwide observational study

Takaki Hirano; Mikio Nakajima; Hiroyuki Ohbe; Richard H Kaszynski; Yudai Iwasaki; Yuki Arakawa; Yusuke Sasabuchi; Kiyohide Fushimi; Hiroki Matsui; Hideo Yasunaga

doi:10.1016/j.resplu.2022.100308

Corticosteroid use with extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A nationwide observational study

Resusc Plus. 2022 Sep 24:12:100308. doi: 10.1016/j.resplu.2022.100308. eCollection 2022 Dec.

Authors

Takaki Hirano¹, Mikio Nakajima^{2

3

4}, Hiroyuki Ohbe³, Richard H Kaszynski⁴, Yudai Iwasaki⁵, Yuki Arakawa⁶, Yusuke Sasabuchi⁷, Kiyohide Fushimi⁸, Hiroki Matsui³, Hideo Yasunaga³

Affiliations

¹ Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima 963-8558, Japan.
² Emergency Life-Saving Technique Academy of Tokyo, Foundation for Ambulance Service Development, 4-5, Minami-Osawa, Hachioji-shi, Tokyo 192-0364, Japan.
³ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
⁴ Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan.
⁵ Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
⁶ Doctoral Program, Social Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁷ Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
⁸ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.

Abstract

Aim: Several studies have reported that corticosteroid administration for cardiac arrest patients may improve outcomes. However, these previous studies have not examined the effect of corticosteroid use in out-of-hospital cardiac arrest (OHCA) patients administered extracorporeal cardiopulmonary resuscitation (ECPR). Therefore, we aimed to examine the effectiveness of corticosteroids in OHCA patients administered ECPR.

Methods: Using the Japanese Diagnosis Procedure Combination inpatient database, we included OHCA patients who were administered ECPR on the day of admission between July 2010 and March 2019. The patients were categorized into the corticosteroid and control groups according to whether they received corticosteroids on the day of admission or not. The primary outcome was in-hospital mortality and the secondary outcomes included percentages of neurologically favorable survival, major bleeding complications, and infection-related complications. We compared the outcomes using a propensity score matching analysis.

Results: We identified 6,142 eligible patients (459 vs 5,683, the corticosteroid and control group, respectively). One-to-four propensity score matching analysis (457 vs 1,827) showed in-hospital mortality was significantly higher in the corticosteroid group compared with the control group (82.1% vs 76.6%; risk difference, 5.5%; 95% CI, 1.5 to 9.5%). Neurologically favorable outcomes did not differ between the two groups (13.6% vs 16.9%; risk difference, -3.3%; 95% CI, -6.9 to 0.3%). The percentage of major bleeding complications and infection-related complications did not significantly differ between the two groups.

Conclusions: The results of this study demonstrated that administration of corticosteroids on the day of admission to OHCA patients administered ECPR was associated with increased in-hospital mortality.

Keywords: BMI, body mass index; CI, confidence interval; CPB, cardiopulmonary bypass; CPR, cardiopulmonary resuscitation; Cardiac arrest; Corticosteroid; ECPR, extracorporeal cardiopulmonary resuscitation; Extracorporeal cardiopulmonary resuscitation; ICD-10, International Classification of Diseases, 10th Revision; ICU, intensive care unit; IHCA, in-hospital cardiac arrest; IQR, interquartile ranges; JCS, Japan Coma Scale; OHCA, out-of-hospital cardiac arrest; RCT, randomized controlled trial; ROSC, return of spontaneous circulation; SD, standard deviation.