Login Register Cart 0
Generic placeholder image

Current Medicinal Chemistry

Editor-in-Chief

ISSN (Print): 0929-8673
ISSN (Online): 1875-533X

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe Translate in Chinese
Systematic Review Article

Efficacy of Glucocorticoid Administration in Patients with Cardiac Arrest: A Systematic Review of Clinical Studies

Author(s): Adeleh Sahebnasagh, Farhad Najmeddin, Atabak Najafi, Fatemeh Saghafi, Amin Salehi-Abargouei, Arezoo Ahmadi, Shahideh Amini, Mojtaba Mojtahedzadeh* and Hamidreza Sharifnia

Volume 29, Issue 1, 2022

Published on: 31 May, 2021

Page: [136 - 151] Pages: 16

DOI: 10.2174/0929867328666210531145617

Price: $65

Abstract

Background: The pathophysiology of cardiac arrest (CA) involves over-activation of systemic inflammatory responses, relative adrenal insufficiency, and glycocalyx damage. Corticosteroids have beneficial effects in preventing the perturbation of the endothelial glycocalyx.

Objectives: The aim of this systematic review was to determine the efficacy of glucocorticoids in patients with cardiac arrest.

Methods: We searched PubMed, Scopus, ISI Web of Science, Google Scholar, and Cochrane central register for relevant clinical trials and cohort studies until September 2019.

Results: We retrieved 7 peer-reviewed published studies for the systematic review. Two studies were clinical trials evaluating 147 patients, while five illustrated cohort design, evaluating 196,192 patients. In total, 196,339 patients were assessed. There was limited evidence and conflicting results to establish a correlation between glucocorticoids and the survival of patients suffering from cardiac arrest. However, the links between these medications and survival-to-admission, survival-to discharge, and 1-year survival rates were strong and consistent in observational studies.

Conclusion: The clinical evidence regarding the efficacy and safety of glucocorticoids in CA is limited to observational studies with inconsistent methodology and few clinical trials with a small sample size. Nevertheless, it seems that glucocorticoid supplementation during and after cardiopulmonary resuscitation (CPR) may have beneficial effects in terms of survival-to-admission, survival to discharge, 1-year survival rates, and an improved return of spontaneous circulation (ROSC) rate, especially in patients with hemodynamic instability and cardiovascular diseases (i.e., refractory hemodynamic shock). Future studies with high-quality, large-scale, long-term intervention and precise baseline characteristics are needed to evaluate the exact effective dose, duration, and efficacy of glucocorticoids in CA.

Keywords: Cardiac arrest, glucocorticoids, glycocalyx shedding, post-resuscitation syndrome, return of spontaneous circulation, survival.

« Previous Next »
[1]
Jacobs, I.; Nadkarni, V.; Arrest, ITFoC. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: A statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation, 2004, 110(21), 3385-3397.
[2]
Meaney, P.A.; Nadkarni, V.M.; Kern, K.B.; Indik, J.H.; Halperin, H.R.; Berg, R.A. Rhythms and outcomes of adult in-hospital cardiac arrest. Crit. Care Med., 2010, 38(1), 101-108.
[http://dx.doi.org/10.1097/CCM.0b013e3181b43282] [PMID: 19770741]
[3]
Mongardon, N.; Dumas, F.; Ricome, S.; Grimaldi, D.; Hissem, T.; Pène, F.; Cariou, A. Postcardiac arrest syndrome: From immediate resuscitation to long-term outcome. Ann. Intensive Care, 2011, 1(1), 45.
[http://dx.doi.org/10.1186/2110-5820-1-45] [PMID: 22053891]
[4]
Adrie, C.; Laurent, I.; Monchi, M.; Cariou, A.; Dhainaou, J.F.; Spaulding, C. Postresuscitation disease after cardiac arrest: A sepsis-like syndrome? Curr. Opin. Crit. Care, 2004, 10(3), 208-212.
[http://dx.doi.org/10.1097/01.ccx.0000126090.06275.fe] [PMID: 15166838]
[5]
Kolářová, H; Ambrůzová, B; Švihálková Šindlerová, L Modulation of endothelial glycocalyx structure under inflammatory conditions. Mediators Inflamm., 2014.694312.
[6]
Reitsma, S.; Slaaf, D.W.; Vink, H.; van Zandvoort, M.A.; oude Egbrink, M.G. The endothelial glycocalyx: Composition, functions, and visualization. Pflugers Arch., 2007, 454(3), 345-359.
[http://dx.doi.org/10.1007/s00424-007-0212-8] [PMID: 17256154]
[7]
Grundmann, S.; Fink, K.; Rabadzhieva, L.; Bourgeois, N.; Schwab, T.; Moser, M.; Bode, C.; Busch, H.J. Perturbation of the endothelial glycocalyx in post cardiac arrest syndrome. Resuscitation, 2012, 83(6), 715-720.
[http://dx.doi.org/10.1016/j.resuscitation.2012.01.028] [PMID: 22306259]
[8]
Jacob, M.; Saller, T.; Chappell, D.; Rehm, M.; Welsch, U.; Becker, B.F. Physiological levels of A-, B- and C-type natriuretic peptide shed the endothelial glycocalyx and enhance vascular permeability. Basic Res. Cardiol., 2013, 108(3), 347.
[http://dx.doi.org/10.1007/s00395-013-0347-z] [PMID: 23563917]
[9]
Nagao, K.; Hayashi, N.; Kanmatsuse, K.; Kikuchi, S.; Kikushima, K.; Watanabe, K.; Mukouyama, T. B-type natriuretic peptide as a marker of resuscitation in patients with cardiac arrest outside the hospital. Circ. J., 2004, 68(5), 477-482.
[http://dx.doi.org/10.1253/circj.68.477] [PMID: 15118292]
[10]
Wei, S.; Loyo-Berríos, N.I.; Haigney, M.C.; Cheng, H.; Pinnow, E.E.; Mitchell, K.R.; Beachy, J.H.; Woodward, A.M.; Wang, Y.; Curtis, J.P.; Marinac-Dabic, D. Elevated B-type natriuretic peptide is associated with increased in-hospital mortality or cardiac arrest in patients undergoing implantable cardioverter-defibrillator implantation. Circ. Cardiovasc. Qual. Outcomes, 2011, 4(3), 346-354.
[http://dx.doi.org/10.1161/CIRCOUTCOMES.110.943621] [PMID: 21487093]
[11]
Sodeck, G.H.; Domanovits, H.; Sterz, F.; Schillinger, M.; Losert, H.; Havel, C.; Kliegel, A.; Vlcek, M.; Frossard, M.; Laggner, A.N. Can brain natriuretic peptide predict outcome after cardiac arrest? An observational study. Resuscitation, 2007, 74(3), 439-445.
[http://dx.doi.org/10.1016/j.resuscitation.2007.02.001] [PMID: 17451863]
[12]
Chappell, D.; Jacob, M.; Hofmann-Kiefer, K.; Bruegger, D.; Rehm, M.; Conzen, P.; Welsch, U.; Becker, B.F. Hydrocortisone preserves the vascular barrier by protecting the endothelial glycocalyx. Anesthesiology, 2007, 107(5), 776-784.
[http://dx.doi.org/10.1097/01.anes.0000286984.39328.96] [PMID: 18073553]
[13]
Cain, D.W.; Cidlowski, J.A. Immune regulation by glucocorticoids. Nat. Rev. Immunol., 2017, 17(4), 233-247.
[http://dx.doi.org/10.1038/nri.2017.1] [PMID: 28192415]
[14]
Hékimian, G.; Baugnon, T.; Thuong, M.; Monchi, M.; Dabbane, H.; Jaby, D.; Rhaoui, A.; Laurent, I.; Moret, G.; Fraisse, F.; Adrie, C. Cortisol levels and adrenal reserve after successful cardiac arrest resuscitation. Shock, 2004, 22(2), 116-119.
[http://dx.doi.org/10.1097/01.shk.0000132489.79498.c7] [PMID: 15257083]
[15]
Kim, J.J.; Lim, Y.S.; Shin, J.H.; Yang, H.J.; Kim, J.K.; Hyun, S.Y.; Rhoo, I.; Hwang, S.Y.; Lee, G. Relative adrenal insufficiency after cardiac arrest: Impact on postresuscitation disease outcome. Am. J. Emerg. Med., 2006, 24(6), 684-688.
[http://dx.doi.org/10.1016/j.ajem.2006.02.017] [PMID: 16984836]
[16]
Kim, J.J.; Hyun, S.Y.; Hwang, S.Y.; Jung, Y.B.; Shin, J.H.; Lim, Y.S.; Cho, J.S.; Yang, H.J.; Lee, G. Hormonal responses upon return of spontaneous circulation after cardiac arrest: A retrospective cohort study. Crit. Care, 2011, 15(1), R53.
[http://dx.doi.org/10.1186/cc10019] [PMID: 21299901]
[17]
Schultz, C.H.; Rivers, E.P.; Feldkamp, C.S.; Goad, E.G.; Smithline, H.A.; Martin, G.B.; Fath, J.J.; Wortsman, J.; Nowak, R.M. A characterization of hypothalamic-pituitary-adrenal axis function during and after human cardiac arrest. Crit. Care Med., 1993, 21(9), 1339-1347.
[http://dx.doi.org/10.1097/00003246-199309000-00018] [PMID: 8396524]
[18]
Wells, G. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. 2004. http://www, ohri ca/programs/clinical_epidemiology oxford htm.
[19]
Higgins, J.P.; Altman, D.G.; Gøtzsche, P.C.; Jüni, P.; Moher, D.; Oxman, A.D.; Savovic, J.; Schulz, K.F.; Weeks, L.; Sterne, J.A. The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343, d5928.
[http://dx.doi.org/10.1136/bmj.d5928] [PMID: 22008217]
[20]
Donnino, M.W.; Andersen, L.W.; Berg, K.M.; Chase, M.; Sherwin, R.; Smithline, H.; Carney, E.; Ngo, L.; Patel, P.V.; Liu, X.; Cutlip, D.; Zimetbaum, P.; Cocchi, M.N. Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial. Crit. Care, 2016, 20(1), 82.
[http://dx.doi.org/10.1186/s13054-016-1257-x] [PMID: 27038920]
[21]
Tsai, M-S.; Huang, C-H.; Chang, W-T.; Chen, W.J.; Hsu, C.Y.; Hsieh, C.C.; Yang, C.W.; Chiang, W.C.; Ma, M.H.; Chen, S.C. The effect of hydrocortisone on the outcome of out-of-hospital cardiac arrest patients: A pilot study. Am. J. Emerg. Med., 2007, 25(3), 318-325.
[http://dx.doi.org/10.1016/j.ajem.2006.12.007] [PMID: 17349907]
[22]
Tsai, M-S.; Chuang, P-Y.; Huang, C-H.; Tang, C.H.; Yu, P.H.; Chang, W.T.; Chen, W.J. Postarrest steroid use may improve outcomes of cardiac arrest survivors. Crit. Care Med., 2019, 47(2), 167-175.
[http://dx.doi.org/10.1097/CCM.0000000000003468] [PMID: 30308548]
[23]
Tsai, M-S.; Chuang, P-Y.; Yu, P-H.; Huang, C.H.; Tang, C.H.; Chang, W.T.; Chen, W.J. Glucocorticoid use during cardiopulmonary resuscitation may be beneficial for cardiac arrest. Int. J. Cardiol., 2016, 222, 629-635.
[http://dx.doi.org/10.1016/j.ijcard.2016.08.017] [PMID: 27517652]
[24]
Jastremski, M.; Sutton-Tyrrell, K.; Vaagenes, P.; Abramson, N.; Heiselman, D.; Safar, P. Glucocorticoid treatment does not improve neurological recovery following cardiac arrest. JAMA, 1989, 262(24), 3427-3430.
[http://dx.doi.org/10.1001/jama.1989.03430240063030] [PMID: 2685382]
[25]
Niimura, T.; Zamami, Y.; Koyama, T.; Izawa-Ishizawa, Y.; Miyake, M.; Koga, T.; Harada, K.; Ohshima, A.; Imai, T.; Kondo, Y.; Imanishi, M.; Takechi, K.; Fukushima, K.; Horinouchi, Y.; Ikeda, Y.; Fujino, H.; Tsuchiya, K.; Tamaki, T.; Hinotsu, S.; Kano, M.R.; Ishizawa, K. Hydrocortisone administration was associated with improved survival in Japanese patients with cardiac arrest. Sci. Rep., 2017, 7(1), 17919.
[http://dx.doi.org/10.1038/s41598-017-17686-3] [PMID: 29263333]
[26]
Grafton, S.T.; Longstreth, W.T.Jr. Steroids after cardiac arrest: a retrospective study with concurrent, nonrandomized controls. Neurology, 1988, 38(8), 1315-1316.
[http://dx.doi.org/10.1212/WNL.38.8.1315] [PMID: 3399081]
[27]
Marik, P.E. The role of glucocorticoids as adjunctive treatment for sepsis in the modern era. Lancet Respir. Med., 2018, 6(10), 793-800.
[http://dx.doi.org/10.1016/S2213-2600(18)30265-0] [PMID: 30006071]
[28]
Adrie, C.; Adib-Conquy, M.; Laurent, I.; Monchi, M.; Vinsonneau, C.; Fitting, C.; Fraisse, F.; Dinh-Xuan, A.T.; Carli, P.; Spaulding, C.; Dhainaut, J.F.; Cavaillon, J.M. Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation, 2002, 106(5), 562-568.
[http://dx.doi.org/10.1161/01.CIR.0000023891.80661.AD] [PMID: 12147537]
[29]
Omar, Y.G.; Massey, M.; Andersen, L.W.; Giberson, T.A.; Berg, K.; Cocchi, M.N.; Shapiro, N.I.; Donnino, M.W. Sublingual microcirculation is impaired in post-cardiac arrest patients. Resuscitation, 2013, 84(12), 1717-1722.
[http://dx.doi.org/10.1016/j.resuscitation.2013.07.012] [PMID: 23871865]
[30]
Keh, D.; Boehnke, T.; Weber-Cartens, S.; Schulz, C.; Ahlers, O.; Bercker, S.; Volk, H.D.; Doecke, W.D.; Falke, K.J.; Gerlach, H. Immunologic and hemodynamic effects of “low-dose” hydrocortisone in septic shock: A double-blind, randomized, placebo-controlled, crossover study. Am. J. Respir. Crit. Care Med., 2003, 167(4), 512-520.
[http://dx.doi.org/10.1164/rccm.200205-446OC] [PMID: 12426230]
[31]
Aguilar, D.; Strom, J.; Chen, Q.M. Glucocorticoid induced leucine zipper inhibits apoptosis of cardiomyocytes by doxorubicin. Toxicol. Appl. Pharmacol., 2014, 276(1), 55-62.
[http://dx.doi.org/10.1016/j.taap.2014.01.013] [PMID: 24480152]
[32]
Oh, H.Y.; Namkoong, S.; Lee, S.J.; Por, E.; Kim, C.K.; Billiar, T.R.; Han, J.A.; Ha, K.S.; Chung, H.T.; Kwon, Y.G.; Lee, H.; Kim, Y.M. Dexamethasone protects primary cultured hepatocytes from death receptor-mediated apoptosis by upregulation of cFLIP. Cell Death Differ., 2006, 13(3), 512-523.
[http://dx.doi.org/10.1038/sj.cdd.4401771] [PMID: 16167066]
[33]
van der Poll, T.; Lowry, S.F. Lipopolysaccharide-induced interleukin 8 production by human whole blood is enhanced by epinephrine and inhibited by hydrocortisone. Infect. Immun., 1997, 65(6), 2378-2381.
[http://dx.doi.org/10.1128/IAI.65.6.2378-2381.1997] [PMID: 9169777]
[34]
Katz, L.; Vaagenes, P.; Safar, P.; Diven, W. Brain enzyme changes as markers of brain damage in rat cardiac arrest model. Effects of corticosteroid therapy. Resuscitation, 1989, 17(1), 39-53.
[http://dx.doi.org/10.1016/0300-9572(89)90078-6] [PMID: 2538900]
[35]
Vaahersalo, J.; Skrifvars, M.B.; Pulkki, K.; Stridsberg, M.; Røsjø, H.; Hovilehto, S.; Tiainen, M.; Varpula, T.; Pettilä, V.; Ruokonen, E. Admission interleukin-6 is associated with post resuscitation organ dysfunction and predicts long-term neurological outcome after out-of-hospital ventricular fibrillation. Resuscitation, 2014, 85(11), 1573- 1579.
[http://dx.doi.org/10.1016/j.resuscitation.2014.08.036] [PMID: 25238742]
[36]
Peberdy, M.A.; Andersen, L.W.; Abbate, A.; Thacker, L.R.; Gaieski, D.; Abella, B.S.; Grossestreuer, A.V.; Rittenberger, J.C.; Clore, J.; Ornato, J.; Cocchi, M.N.; Callaway, C.; Donnino, M. Inflammatory markers following resuscitation from out-of-hospital cardiac arrest-A prospective multicenter observational study. Resuscitation, 2016, 103, 117-124.
[http://dx.doi.org/10.1016/j.resuscitation.2016.01.006] [PMID: 26826561]
[37]
Hafezi-Moghadam, A.; Simoncini, T.; Yang, Z.; Limbourg, F.P.; Plumier, J.C.; Rebsamen, M.C.; Hsieh, C.M.; Chui, D.S.; Thomas, K.L.; Prorock, A.J.; Laubach, V.E.; Moskowitz, M.A.; French, B.A.; Ley, K.; Liao, J.K. Acute cardiovascular protective effects of corticosteroids are mediated by non-transcriptional activation of endothelial nitric oxide synthase. Nat. Med., 2002, 8(5), 473-479.
[http://dx.doi.org/10.1038/nm0502-473] [PMID: 11984591]
[38]
Mukaida, N.; Zachariae, C.C.; Gusella, G.L.; Matsushima, K. Dexamethasone inhibits the induction of monocyte chemotactic-activating factor production by IL-1 or tumor necrosis factor. J. Immunol., 1991, 146(4), 1212-1215.
[PMID: 1991962]
[39]
Grünfeld, J-P.; Eloy, L. Glucocorticoids modulate vascular reactivity in the rat. Hypertension, 1987, 10(6), 608-618.
[http://dx.doi.org/10.1161/01.HYP.10.6.608] [PMID: 3692572]
[40]
Romero, I.A.; Radewicz, K.; Jubin, E.; Michel, C.C.; Greenwood, J.; Couraud, P.O.; Adamson, P. Changes in cytoskeletal and tight junctional proteins correlate with decreased permeability induced by dexamethasone in cultured rat brain endothelial cells. Neurosci. Lett., 2003, 344(2), 112-116.
[http://dx.doi.org/10.1016/S0304-3940(03)00348-3] [PMID: 12782340]
[41]
Constantinescu, A.A.; Vink, H.; Spaan, J.A. Endothelial cell glycocalyx modulates immobilization of leukocytes at the endothelial surface. Arterioscler. Thromb. Vasc. Biol., 2003, 23(9), 1541-1547.
[http://dx.doi.org/10.1161/01.ATV.0000085630.24353.3D] [PMID: 12855481]
[42]
Vink, H.; Constantinescu, A.A.; Spaan, J.A. Oxidized lipoproteins degrade the endothelial surface layer : Implications for platelet-endothelial cell adhesion. Circulation, 2000, 101(13), 1500-1502.
[http://dx.doi.org/10.1161/01.CIR.101.13.1500] [PMID: 10747340]
[43]
Berger, S. Survival from out-of-hospital cardiac arrest: are we beginning to see progress? Am Heart Assoc, 2017, 6(9)e007469.
[http://dx.doi.org/10.1161/JAHA.117.007469] [PMID: 28939721]
[44]
Graham, R.; McCoy, M.A.; Schultz, A.M. Understanding the public health burden of cardiac arrest: The need for national surveillance. Strategies to improve cardiac arrest survival: A time to act; National Academies Press: US, 2015.
[45]
Laver, S.; Farrow, C.; Turner, D.; Nolan, J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med., 2004, 30(11), 2126-2128.
[http://dx.doi.org/10.1007/s00134-004-2425-z] [PMID: 15365608]
[46]
Miller, J.B.; Donnino, M.W.; Rogan, M.; Goyal, N. Relative adrenal insufficiency in post-cardiac arrest shock is under-recognized. Resuscitation, 2008, 76(2), 221-225.
[http://dx.doi.org/10.1016/j.resuscitation.2007.07.034] [PMID: 17875353]
[47]
Pene, F.; Hyvernat, H.; Mallet, V.; Cariou, A.; Carli, P.; Spaulding, C.; Dugue, M.A.; Mira, J.P. Prognostic value of relative adrenal insufficiency after out-of-hospital cardiac arrest. Intensive Care Med., 2005, 31(5), 627-633.
[http://dx.doi.org/10.1007/s00134-005-2603-7] [PMID: 15838680]
[48]
Tavakoli, N.; Bidari, A.; Shams Vahdati, S. Serum cortisol levels as a predictor of neurologic survival insuccessfully resuscitated victims of cardiopulmonary arrest. J. Cardiovasc. Thorac. Res., 2012, 4(4), 107-111.
[PMID: 24250997]
[49]
Chalkias, A.; Xanthos, T. Post-cardiac arrest syndrome: Mechanisms and evaluation of adrenal insufficiency. World J. Crit. Care Med., 2012, 1(1), 4-9.
[http://dx.doi.org/10.5492/wjccm.v1.i1.4] [PMID: 24701395]
[50]
Matsumura, M.; Kakishita, H.; Suzuki, M.; Banba, N.; Hattori, Y. Dexamethasone suppresses iNOS gene expression by inhibiting NF-kappaB in vascular smooth muscle cells. Life Sci., 2001, 69(9), 1067-1077.
[http://dx.doi.org/10.1016/S0024-3205(01)01196-1] [PMID: 11508649]
[51]
Ito, T.; Saitoh, D.; Takasu, A.; Kiyozumi, T.; Sakamoto, T.; Okada, Y. Serum cortisol as a predictive marker of the outcome in patients resuscitated after cardiopulmonary arrest. Resuscitation, 2004, 62(1), 55-60.
[http://dx.doi.org/10.1016/j.resuscitation.2004.02.004] [PMID: 15246584]
[52]
Lindner, K.H.; Strohmenger, H.U.; Ensinger, H.; Hetzel, W.D.; Ahnefeld, F.W.; Georgieff, M. Stress hormone response during and after cardiopulmonary resuscitation. Anesthesiology, 1992, 77(4), 662-668.
[http://dx.doi.org/10.1097/00000542-199210000-00008] [PMID: 1329579]
[53]
Foley, P.J.; Tacker, W.A.; Wortsman, J.; Frank, S.; Cryer, P.E. Plasma catecholamine and serum cortisol responses to experimental cardiac arrest in dogs. Am. J. Physiol., 1987, 253(3 Pt 1), E283-E289.
[PMID: 3631258]
[54]
Kornberger, E.; Prengel, A.W.; Krismer, A.; Schwarz, B.; Wenzel, V.; Lindner, K.H.; Mair, P. Vasopressin-mediated adrenocorticotropin release increases plasma cortisol concentrations during cardiopulmonary resuscitation. Crit. Care Med., 2000, 28(10), 3517-3521.
[http://dx.doi.org/10.1097/00003246-200010000-00028] [PMID: 11057810]
[55]
Smithline, H.; Rivers, E.; Appleton, T.; Nowak, R. Corticosteroid supplementation during cardiac arrest in rats. Resuscitation, 1993, 25(3), 257-264.
[http://dx.doi.org/10.1016/0300-9572(93)90123-8] [PMID: 8351423]
[56]
Mentzelopoulos, S.D.; Zakynthinos, S.G.; Tzoufi, M.; Katsios, N.; Papastylianou, A.; Gkisioti, S.; Stathopoulos, A.; Kollintza, A.; Stamataki, E.; Roussos, C. Vasopressin, epinephrine, and corticosteroids for in-hospital cardiac arrest. Arch. Intern. Med., 2009, 169(1), 15-24.
[http://dx.doi.org/10.1001/archinternmed.2008.509] [PMID: 19139319]
[57]
Mentzelopoulos, S.D.; Malachias, S.; Chamos, C.; Konstantopoulos, D.; Ntaidou, T.; Papastylianou, A.; Kolliantzaki, I.; Theodoridi, M.; Ischaki, H.; Makris, D.; Zakynthinos, E.; Zintzaras, E.; Sourlas, S.; Aloizos, S.; Zakynthinos, S.G. Vasopressin, steroids, and epinephrine and neurologically favorable survival after in-hospital cardiac arrest: A randomized clinical trial. JAMA, 2013, 310(3), 270-279.
[http://dx.doi.org/10.1001/jama.2013.7832] [PMID: 23860985]
[58]
American Heart Association, 2015. Available at: https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/

Rights & Permissions Print Cite
Article Metrics
27
1
© 2024 Bentham Science Publishers | Privacy Policy