The inflammatory response is related to circulatory failure after out-of-hospital cardiac arrest: A prospective cohort study. (January 2022)

• Record Type: Journal Article
• Authors: Langeland, Halvor; Damås, Jan Kristian; Mollnes, Tom Eirik; Ludviksen, Judith Krey; Ueland, Thor; Michelsen, Annika E.; Løberg, Magnus; Bergum, Daniel; Nordseth, Trond; Skjærvold, Nils Kristian; Klepstad, Pål
• Is Part Of: Resuscitation. Volume 170(2022)
• Page Start: 115
• Page End: 125
• Publication Date: 2022-01
• Subjects: Post-cardiac arrest syndrome -- Out-of-hospital cardiac arrest -- Inflammation -- Biomarkers -- Haemodynamic; C3bc complement 3 activation product -- CO cardiac output -- CRP c-reactive protein -- BFGF basic fibroblast growth factor -- ECMO extracorporeal membranous oxygenation -- ICAM-1 intercellular adhesion molecule 1 -- ICU intensive care unit -- IFNγ interferon gamma -- IL interleukin -- IP-10 interferon-inducible protein 10 -- MAP mean arterial blood pressure -- mCPIS modified Clinical Pneumonia Infection Score -- MIP-1β macrophage inflammatory protein 1 beta -- OHCA out-of-hospital cardiac arrest -- PCAS post-cardiac arrest syndrome -- PDGF-BB platelet derived growth factor-BB -- Q1–Q3 first to third quartile -- RANTES regulated on activation normal T-cell expressed and secreted -- ROSC return of spontaneous circulation -- SOFA sequential organ failure assessment -- SVR systemic vascular resistance -- TCC terminal C5b-9 complement complex -- TNF tumor necrosis factor -- VAD ventricular assist device -- VCAM-1 vascular cell adhesion molecule 1 -- vWF von Willebrand factor; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2021.11.026
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Background: Whole body ischemia and reperfusion injury after cardiac arrest leads to the massive inflammation clinically manifested in the post-cardiac arrest syndrome. Previous studies on the inflammatory effect on circulatory failure after cardiac arrest have either investigated a selected patient group or a limited part of the inflammatory mechanisms. We examined the association between cardiac arrest characteristics and inflammatory biomarkers, and between inflammatory biomarkers and circulatory failure after cardiac arrest, in an unselected patient cohort. Methods: This was a prospective study of 50 consecutive patients with out-of-hospital cardiac arrest. Circulation was invasively monitored from admission until day five, whereas inflammatory biomarkers, i.e. complement activation, cytokines and endothelial injury, were measured daily. We identified predictors for an increased inflammatory response, and associations between the inflammatory response and circulatory failure. Results: We found a marked and broad inflammatory response in patients after cardiac arrest, which was associated with clinical outcome. Long time to return of spontaneous circulation and high lactate level at admission were associated with increased complement activation (TCC and C3bc), pro-inflammatory cytokines (IL-6, IL-8) and endothelial injury (syndecan-1) at admission. These biomarkers were in turn significantly associated with lower mean arterial blood pressure, lower cardiac output and lower systemic vascular resistance, and increased need of circulatory support in the initial phase. High levels of TCC and IL-6 at admission were significantly associated with increased 30-days mortality. Conclusion: Inflammatory biomarkers, including complement activation, cytokines and endothelial injury, were associated with increased circulatory failure in the initial period after cardiac arrest.