Hydrocortisone, ascorbic acid, thiamine of limited benefit in comatose OHCA patients

Early treatment with hydrocortisone, ascorbic acid, and thiamine does little to improve outcomes in comatose out-of-hospital cardiac arrest (OHCA) patients, according to a study.

The study included 160 participants (76.9 percent male) comatose OHCA patients undergoing targeted temperature management. These patients were randomly assigned to receive intravenous hydrocortisone 100 mg, ascorbic acid 50 mg/kg, and thiamine 200 mg (treatment group, n=80) or placebo (n=80). Treatment was administered every 12 h for 3 days.

The primary outcome was peak neuron-specific enolase (NSE) concentration, defined as the highest available value measured at 48 or 72 h after return of spontaneous circulation.

A total of 147 participants were included in the modified intention-to-treat (mITT) analysis, including 74 in the treatment group and 73 in the placebo group. Peak NSE levels did not significantly differ between the two groups: 47.4 ng/mL in the treatment group vs 53.3 ng/mL in the placebo group (median difference, −5.9 ng/mL, 95 percent confidence interval [CI], −34.5 to 40.8; p=0.54).

Results were consistent in ITT sensitivity analysis (geometric mean ratio, 0.94, 95 percent CI, 0.61–1.46; p=0.80).

The treatment and placebo groups also had similar 180-day outcomes, including survival (63.5 percent vs 69.9 percent, respectively) and good neurological outcome (54.1 percent vs 56.2 percent, respectively).

Serious adverse events occurred in 52.5 percent of patients in the treatment group vs 50 percent of those in the placebo group, with none deemed related to the study medication.

The findings provide no evidence of a neuroprotective benefit of hydrocortisone, ascorbic acid, and thiamine in comatose OHCA patients.