Purpose: Several studies showed steroid use following cardiac arrest may improve outcomes in cardiac arrest survivors. However, the study evaluating the effect of steroid administrated during hospitalization on outcomes in cardiac arrest survivors with either chronic obstructive pulmonary disease (COPD) or asthma is lacking. The current study aimed to evaluate the effect of post-arrest steroid use on outcomes of cardiac arrest survivors with either COPD or asthma by using a population–based analysis.
Methods:There were 22,768 adult non-traumatic cardiac arrest survivors from the Taiwan National Health Insurance Research database during 2004 through 2011.  After excluding patients with steroid use during resuscitation, patients with steroid use of mega-dose, and patients neither COPD nor asthma, 4,175 patients with either COPD or asthma were finally enrolled. Based on whether steroid was used or not during hospitalization, these patients were classified into the steroid and non-steroid groups. The underlying characteristics, pre-arrest steroid use or not, the CPR events, hospital level and geographic distribution of these 2 groups were matched by a propensity score. 
Results:After propensity score matching, both the steroid and non-steroid groups had 1681 patients. The inhospital mortality rate was higher in the non-steroid group (84.65%) as compared to steroid group (73.65%) (adjusted HR: 0.43, 95% CI: 0.40-0.47). There were less patients in the steroid group died within 1 year  than in the non-steroid group (84.3% vs 92.5%, adjusted HR: 0.47, 95% CI: 0.44-0.51). Post-arrest steroid use was significantly associated with survival-to-discharge in patients with asthma or COPD, regardless of stratification of age, gender, diabetes, COPD, asthma, shockable rhythm, and steroid use prior to cardiac arrest, respectively. The 1-year survival curves of both groups were plotted.
Conclusion: Post-arrest steroid use is associated with improved survival to hospital discharge and 1-year survival in cardiac arrest survivors with either COPD or asthma.

5 - Impact of post-arrest steroid use on outcomes of cardiac arrest survivors with either COPD or asthma