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

Halvor Langeland; Jan Kristian Damås; Tom Eirik Mollnes; Judith Krey Ludviksen; Thor Ueland; Annika E Michelsen; Magnus Løberg; Daniel Bergum; Trond Nordseth; Nils Kristian Skjærvold; Pål Klepstad

doi:10.1016/j.resuscitation.2021.11.026

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

Resuscitation. 2022 Jan:170:115-125. doi: 10.1016/j.resuscitation.2021.11.026. Epub 2021 Nov 24.

Authors

Affiliations

¹ Department of Anaesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway; Institute of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. Electronic address: halvor.langeland@ntnu.no.
² Gemini Center for Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Centre of Molecular Inflammation Research, Institute for Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Infectious Diseases, St. Olav's University Hospital, Trondheim, Norway.
³ Centre of Molecular Inflammation Research, Institute for Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway; Research Laboratory, Nordland Hospital, Bodø, Norway; K. G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway.
⁴ Research Laboratory, Nordland Hospital, Bodø, Norway.
⁵ K. G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital (Rikshospitalet), Oslo, Norway.
⁶ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital (Rikshospitalet), Oslo, Norway.
⁷ Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
⁸ Department of Anaesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway.
⁹ Department of Anaesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway; Institute of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Anaesthesia, Molde Hospital, Molde, Norway.
¹⁰ Department of Anaesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway; Institute of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

PMID: 34838662
DOI: 10.1016/j.resuscitation.2021.11.026

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.

Keywords: Biomarkers; Haemodynamic; Inflammation; Out-of-hospital cardiac arrest; Post-cardiac arrest syndrome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomarkers
Cohort Studies
Humans
Out-of-Hospital Cardiac Arrest*
Post-Cardiac Arrest Syndrome*
Prospective Studies
Shock* / complications

Substances

Biomarkers