Serum cortisol levels as a predictor of neurologic survival in successfully resuscitated victims of cardiopulmonary arrest

ABSTRACT

Out-of-hospital cardiac arrest [OHCA] is the most stressful lifetime event for the victims and an important issue for the emergency physicians. The status of the hypothalamic pituitary- adrenal axis [HPA] function in successfully resuscitated victims of Cardiopulmonary arrest has been recently of an interest for the researchers. In a prospective cohort study, 50 successfully resuscitated OHCA victims' serum cortisol levels were measured 5 minutes and 1 hour after return of spontaneous circulation [ROSC]. The data were analyzed comparing the one-week neurologic survival. Fifty blood samples were obtained for serum cortisol levels after 5 minutes of ROSC. Fourteen patients [28%] pronounced death during one hour after CPR. Blood sample from living 36 patients after one hour post-CPR were obtained for second cortisol assay. Eleven patients [22%] were neurologically survived after one week. Seven patients [14%] were discharged finally from hospital with good neurologic recovery. The serum cortisol levels in both the neurologically surviving and the non-surviving after 5 minutes of ROSC patients were 63.4 +/- 13.6 and 43.2 +/- 25.5[microg/ml], [mean +/- S.D., respectively] and after 1 hour of ROSC patients' serum cortisol levels were 64.9 +/- 13.1 and 47.3 +/- 27.1[microg/ml], [mean +/- S.D., respectively]. The difference was significantly higher in neurologically survived group in both 5 minutes and 1 hour after ROSC [P= 0.015 and 0.013 respectively]. serum cortisol levels after 5 minutes and one hour of ROSC in victims of Cardiopulmonary arrest are significantly higher in neurologically survived than non-survived patients