Miller Joseph B, Donnino Michael W, Rogan Michael, Goyal Nikhil
Henry Ford Hospital, Department of Emergency Medicine, 2799 West Grand Boulevard, Detroit, MI 48202, United States.
Resuscitation. 2008 Feb;76(2):221-5. doi: 10.1016/j.resuscitation.2007.07.034. Epub 2007 Sep 17.
Suppression of the adrenal axis may occur frequently in post-cardiac arrest patients. Physiological doses of corticosteroids have been shown to reverse hypotension and decrease mortality in other forms of shock. We sought to investigate current clinical practice pertaining to the evaluation for relative adrenal insufficiency in post-cardiac arrest shock.
We performed a retrospective analysis of post-cardiac arrest patients in an urban emergency department. Inclusion criteria included pre-hospital cardiac arrest patients over the age of 18 with a sustained return of spontaneous circulation that required vasopressor support. Exclusion criteria were traumatic arrest and cardiac arrest in the presence of healthcare personnel. The primary endpoint was the percent of patients in refractory shock that either had their adrenal axis tested or were treated for presumed relative adrenal insufficiency. Data analysis was descriptive in nature.
A total of 79 post-cardiac arrest patients were analyzed. Of the 79 patients, 69 were vasopressor-dependent. Of this group, 13% (9/69) had a cortisol level checked (with or without cosyntropin stimulation). Of those who had a cosyntropin stimulation test performed, 86% met biochemical criteria for relative adrenal insufficiency. Seventeen percent of vasopressor-dependent patients received corticosteroids explicitly for their shock state. Overall, only 32% of patients in refractory shock had testing for relative adrenal insufficiency or received corticosteroids for shock.
Though vasopressor-dependent shock is common in post-cardiac arrest patients, adrenal insufficiency was not considered in the majority of cases.
心脏骤停后患者肾上腺轴功能受抑制的情况可能经常发生。生理剂量的皮质类固醇已被证明可逆转低血压并降低其他类型休克的死亡率。我们试图调查目前关于心脏骤停后休克患者相对肾上腺功能不全评估的临床实践情况。
我们对一家城市急诊科的心脏骤停后患者进行了回顾性分析。纳入标准包括年龄超过18岁、院外心脏骤停且自主循环持续恢复但需要血管升压药支持的患者。排除标准为创伤性心脏骤停和在医护人员在场情况下发生的心脏骤停。主要终点是难治性休克患者中进行了肾上腺轴检测或因假定的相对肾上腺功能不全而接受治疗的患者百分比。数据分析本质上是描述性的。
共分析了79例心脏骤停后患者。在这79例患者中，69例依赖血管升压药。在该组患者中，13%（9/69）进行了皮质醇水平检查（无论是否进行促肾上腺皮质激素刺激试验）。在进行促肾上腺皮质激素刺激试验的患者中，86%符合相对肾上腺功能不全的生化标准。17%依赖血管升压药的患者因休克状态明确接受了皮质类固醇治疗。总体而言，难治性休克患者中只有32%进行了相对肾上腺功能不全检测或因休克接受了皮质类固醇治疗。
尽管依赖血管升压药的休克在心脏骤停后患者中很常见，但大多数情况下并未考虑肾上腺功能不全。
