Abstract 60: Adrenal Insufficiency in Post-Cardiac Arrest Shock Is Underrecognized
Introduction: Suppression of the adrenal axis occurs in the majority of post-cardiac arrest patients. Physiologic dosages of steroids have been shown to reverse hypotension and improve mortality in other forms of shock. We sought to assess the hypothesis that relative adrenal insufficiency (RAI) is not sufficiently considered and treated in post-cardiac arrest patients with vasopressor-dependent shock.
Methods: 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 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 RAI. Data analysis was descriptive in nature.
Results: A total of 79 post-cardiac arrest patients were analyzed. Of the 79 patients, 69 were vasopressor-dependent. Of this group, only 13% (9/69) had a cortisol level checked (with or without cosyntropin stimulation). Of those who had a cosyntropin stimulation tests performed, 86% (6/7) met criteria for RAI. Among these patients with confirmed RAI, 67% (4/6) received corticosteroids. Independent of whether or not cortisol was measured, 30.4 % (21/69) of vasopressor-dependent patients were treated with physiologic dose steroids. Nevertheless, only 57.1% (12/21) of these patients were provided steroids because of their shock state. The remaining 42.9% received steroids specifically for another indication such as asthma. Finally, 66.7% (46/69) of all vasopressor-dependent patients died without testing for RAI or receiving corticosteroids for shock.
Conclusions: Though vasopressor-dependent shock is common in post-cardiac arrest patients, adrenal insufficiency was not considered in the majority of cases. Adrenal insufficiency should be considered and treated in this high-risk population.