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Xie Y, Lin L, Sun C, Chen L, Lv W. Association between serum alkaline phosphatase and clinical prognosis in patients with acute liver failure following cardiac arrest: a retrospective cohort study. Eur J Med Res 2024; 29:453. [PMID: 39252119 PMCID: PMC11382480 DOI: 10.1186/s40001-024-02049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 09/02/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Acute liver failure (ALF) following cardiac arrest (CA) poses a significant healthcare challenge, characterized by high morbidity and mortality rates. This study aims to assess the correlation between serum alkaline phosphatase (ALP) levels and poor outcomes in patients with ALF following CA. METHODS A retrospective analysis was conducted utilizing data from the Dryad digital repository. The primary outcomes examined were intensive care unit (ICU) mortality, hospital mortality, and unfavorable neurological outcome. Multivariable logistic regression analysis was employed to assess the relationship between serum ALP levels and clinical prognosis. The predictive value was evaluated using receiver operator characteristic (ROC) curve analysis. Two prediction models were developed, and model comparison was performed using the likelihood ratio test (LRT) and the Akaike Information Criterion (AIC). RESULTS A total of 194 patients were included in the analysis (72.2% male). Multivariate logistic regression analysis revealed that a one-standard deviation increase of ln-transformed ALP were independently associated with poorer prognosis: ICU mortality (odds ratios (OR) = 2.49, 95% confidence interval (CI) 1.31-4.74, P = 0.005), hospital mortality (OR = 2.21, 95% CI 1.18-4.16, P = 0.014), and unfavorable neurological outcome (OR = 2.40, 95% CI 1.25-4.60, P = 0.009). The area under the ROC curve for clinical prognosis was 0.644, 0.642, and 0.639, respectively. Additionally, LRT analyses indicated that the ALP-combined model exhibited better predictive efficacy than the model without ALP. CONCLUSIONS Elevated serum ALP levels upon admission were significantly associated with poorer prognosis of ALF following CA, suggesting its potential as a valuable marker for predicting prognosis in this patient population.
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Affiliation(s)
- Yuequn Xie
- Department of Emergency, The Third Affiliated to Shanghai University, Wenzhou People's Hospital, No. 299 Guan Road, Louqiao Street, Ouhai District, Wenzhou, 325000, Zhejiang, China
| | - Liangen Lin
- Department of Emergency, The Third Affiliated to Shanghai University, Wenzhou People's Hospital, No. 299 Guan Road, Louqiao Street, Ouhai District, Wenzhou, 325000, Zhejiang, China
| | - Congcong Sun
- Department of Scientific Research Center, The Third Affiliated to Shanghai University, Wenzhou People's Hospital, Wenzhou, 325000, Zhejiang, China
| | - Linglong Chen
- Department of Emergency, The Third Affiliated to Shanghai University, Wenzhou People's Hospital, No. 299 Guan Road, Louqiao Street, Ouhai District, Wenzhou, 325000, Zhejiang, China
| | - Wang Lv
- Department of Emergency, The Third Affiliated to Shanghai University, Wenzhou People's Hospital, No. 299 Guan Road, Louqiao Street, Ouhai District, Wenzhou, 325000, Zhejiang, China.
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Abi Zeid Daou Y, Lidouren F, Bois A, Watanabe N, Jendoubi A, Faucher E, Surenaud M, Chateau-Joubert S, Hue S, Ghaleh B, Kohlhauer M, Tissier R. Investigation of fingolimod-induced lymphocyte sequestration on inflammatory response and neurological damages after cardiac arrest. Intensive Care Med Exp 2024; 12:57. [PMID: 38954057 PMCID: PMC11219599 DOI: 10.1186/s40635-024-00645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND A sepsis-like syndrome is known to occur after cardiac arrest, leading to cerebral infiltration by white blood cells (WBC). We hypothesized that pharmacological sequestration of WBC, and more specifically lymphocytes within lymphoid tissues, could reduce the cerebral infiltration by these inflammatory cells and subsequent acute brain injury in a porcine model of cardiac arrest. Lymphocyte sequestration was induced by the sphingosine-1 phosphate receptors agonist fingolimod. METHODS In a first set of experiments, anesthetized pigs underwent a sham instrumentation with no cardiac arrest (n = 4). They received an administration of fingolimod (1 mg/kg, i.v.) in order to confirm its effect on WBC. In a second set of experiments, animals randomly received fingolimod or saline two hours prior to an episode of ventricular fibrillation (14 min) with subsequent resuscitation (n = 6 in each group). Neurological injury was assessed 24 h after resuscitation. RESULTS In the first set of experiments, WBC and blood lymphocyte counts were significantly reduced by - 61 ± 10% and - 75 ± 6% two hours after fingolimod administration. In the second set of experiments, blood lymphocyte counts, but not WBC, were also significantly reduced after cardiac arrest in Fingolimod vs Control group. However, most cytokine blood levels were not different among groups, including Interleukin (IL)-1ra, IL-8 or IL-18 blood levels. A difference was only observed for IL-6, which decreased in Fingolimod vs Control (e.g., 5.6 ± 4.8 vs 59.4 ± 20.6 pg/ml at 2 h after cardiac arrest, respectively; p = 0.126). Neurofilament light chain (NFL) blood levels were not different among groups (57 ± 25 vs 84 ± 41 pg/ml in Fingolimod vs Control at 6 h after resuscitation, respectively). After awakening, 3 and 2 animals were prematurely euthanized for ethical reasons due to recurrent seizures in Fingolimod and Control groups, respectively. At Day 1, neurological dysfunction score was not different between groups (87 ± 7 vs 87 ± 5% in Fingolimod vs Control, respectively). Conversely, a decrease in the number of CD3 + cells was observed in the brain of surviving animals in Fingolimod vs Control group (3.10 ± 0.50 vs 7.53 ± 0.57 CD3 + cells/field, respectively; p = 0.0286). CONCLUSION Fingolimod-induced WBC sequestration, and more specifically lymphocytes sequestration, did not improve clinical neurological dysfunction following cardiac arrest although it reduced cerebral infiltration by lymphocytes.
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Affiliation(s)
- Yara Abi Zeid Daou
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- Ecole Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Fanny Lidouren
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- Ecole Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Antoine Bois
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- Ecole Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
- Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Paris Centre, Hopital Cochin, Paris, France
| | - Naoto Watanabe
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- Ecole Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Ali Jendoubi
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- Ecole Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Estelle Faucher
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- Ecole Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Mathieu Surenaud
- Vaccine Research Institute, Univ Paris Est-Creteil, 94000, Creteil, France
| | - Sophie Chateau-Joubert
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- Ecole Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Sophie Hue
- Vaccine Research Institute, Univ Paris Est-Creteil, 94000, Creteil, France
| | - Bijan Ghaleh
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- Ecole Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Matthias Kohlhauer
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- Ecole Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Renaud Tissier
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France.
- Ecole Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France.
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Renz M, Müller L, Herbst M, Riedel J, Mohnke K, Ziebart A, Ruemmler R. Analysis of cerebral Interleukin-6 and tumor necrosis factor alpha patterns following different ventilation strategies during cardiac arrest in pigs. PeerJ 2023; 11:e16062. [PMID: 37790622 PMCID: PMC10544304 DOI: 10.7717/peerj.16062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/17/2023] [Indexed: 10/05/2023] Open
Abstract
Hypoxia-induced neuroinflammation after cardiac arrest has been shown to be mitigated by different ventilation methods. In this prospective randomized animal trial, 35 landrace pigs were randomly divided into four groups: intermittent positive pressure ventilation (IPPV), synchronized ventilation 20 mbar (SV 20 mbar), chest compression synchronized ventilation 40 mbar (CCSV 40 mbar) and a control group (Sham). After inducing ventricular fibrillation, basic life support (BLS) and advanced life support (ALS) were performed, followed by post-resuscitation monitoring. After 6 hours, the animals were euthanized, and direct postmortem brain tissue samples were taken from the hippocampus (HC) and cortex (Cor) for molecular biological investigation of cytokine mRNA levels of Interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα). The data analysis showed that CCSV 40 mbar displayed low TNFα mRNA-levels, especially in the HC, while the highest TNFα mRNA-levels were detected in SV 20 mbar. The results indicate that chest compression synchronized ventilation may have a potential positive impact on the cytokine expression levels post-resuscitation. Further studies are needed to derive potential therapeutic algorithms from these findings.
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Affiliation(s)
- Miriam Renz
- Department of Anesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Germany
| | - Lea Müller
- Department of Anesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Germany
| | - Manuel Herbst
- Institute for Medical Biometry, Epidemiology and Information Technology, University Medical Center of the Johannes Gutenberg Universität, Mainz, Germany
| | - Julian Riedel
- Department of Anesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Germany
| | - Katja Mohnke
- Department of Anesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Germany
| | - Robert Ruemmler
- Department of Anesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Germany
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Abdi Isse Y, Frikke-Schmidt R, Wiberg S, Grand J, Obling LER, Meyer ASP, Kjaergaard J, Hassager C, Meyer MAS. Predicting poor neurological outcomes following out-of-hospital cardiac arrest using neuron-specific enolase and neurofilament light chain in patients with and without haemolysis. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead078. [PMID: 37646044 PMCID: PMC10461601 DOI: 10.1093/ehjopen/oead078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
Aims Hypoxic-ischaemic brain injury following out-of-hospital cardiac arrest (OHCA) is a common complication and a major cause of death. Neuron-specific enolase (NSE) and neurofilament light chain (NfL) are released after brain injury and elevated concentrations of both are associated with poor neurological outcome. We explored the influence of haemolysis on the prognostic performance of NSE and NfL. Methods and results The study is based on post hoc analyses of a randomized, single-centre, double-blinded, controlled trial (IMICA), where comatose OHCA patients of presumed cardiac cause were included. Free-haemoglobin was measured at admission to quantify haemolysis. NSE and NfL were measured after 48 h to estimate the extent of brain injury. Montreal Cognitive Assessment score (MoCA) was assessed to evaluate neurocognitive impairments. Seventy-three patients were included and divided into two groups by the median free-haemoglobin at admission. No group differences in mortality or poor neurological outcome were observed. The high-admission free-haemoglobin group had a significantly higher concentration of NSE compared to the low-admission free-haemoglobin group (27.4 µmol/L vs. 19.6 µmol/L, P = 0.03), but no differences in NfL. The performance of NSE and NfL in predicting poor neurological outcome were high for both, but NfL was numerically higher [area under the ROC (AUROC) 0.90 vs. 0.96, P = 0.09]. Furthermore, NfL, but not NSE, was inversely correlated with MoCA score, R2 = 0.21, P = 0.006. Conclusion High free-haemoglobin at admission was associated with higher NSE concentration after 48 h, but, the performance of NSE and NfL in predicting poor neurological outcome among OHCA patients were good regardless of early haemolysis. Only elevated NfL concentrations were associated with cognitive impairments.
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Affiliation(s)
- Yusuf Abdi Isse
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Center of Diagnostic Investigation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian Wiberg
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
| | - Johannes Grand
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
| | - Laust E R Obling
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
| | - Anna Sina Pettersson Meyer
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin A S Meyer
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK2100 Copenhagen, Denmark
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5
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Meyer MAS, Bjerre M, Wiberg S, Grand J, Obling LER, Meyer ASP, Josiassen J, Frydland M, Thomsen JH, Frikke-Schmidt R, Kjaergaard J, Hassager C. Modulation of inflammation by treatment with tocilizumab after out-of-hospital cardiac arrest and associations with clinical status, myocardial- and brain injury. Resuscitation 2023; 184:109676. [PMID: 36572373 DOI: 10.1016/j.resuscitation.2022.109676] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
AIM To investigate how the inflammatory response after out-of-hospital cardiac arrest (OHCA) is modulated by blocking IL-6-mediated signalling with tocilizumab, and to relate induced changes to clinical status, myocardial- and brain injury. METHODS This is a preplanned substudy of the IMICA trial (ClinicalTrials.gov, NCT03863015). Upon admission 80 comatose OHCA patients were randomized to infusion of tocilizumab or placebo. Inflammation was characterized by a cytokine assay, CRP, and leukocyte differential count; myocardial injury by TnT and NT-proBNP; brain injury by neuron-specific enolase (NSE) and Neurofilament Light chain (NFL), while sequential organ assessment (SOFA) score and Vasoactive-Inotropic Score (VIS) represented overall clinical status. RESULTS Responses for IL-5, IL-6, IL-17, neutrophil as well as monocyte counts, and VIS were affected by tocilizumab treatment (all p < 0.05), while there was no effect on levels of NFL. IL-5 and IL-6 were substantially increased by tocilizumab, while IL-17 was lowered. Neutrophils and monocytes were lower at 24 and 48 hours, and VIS was lower at 24 hours, for the tocilizumab group compared to placebo. Multiple correlations were identified for markers of organ injury and clinical status versus inflammatory markers; this included correlations of neutrophils and monocytes with TnT, NSE, NFL, SOFA- and VIS score for the tocilizumab but not the placebo group. NT-proBNP, NFL and SOFA score correlated with CRP in both groups. CONCLUSIONS Treatment with tocilizumab after OHCA modulated the inflammatory response with notable increases for IL-5, IL-6, and decreases for neutrophils and monocytes, as well as reduced vasopressor and inotropy requirements.
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Affiliation(s)
| | - Mette Bjerre
- Department of Clinical Medicine, Medical/Steno Aarhus Laboratory, Aarhus University, Aarhus, Denmark
| | - Sebastian Wiberg
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Johannes Grand
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | | | - Jakob Josiassen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Martin Frydland
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Center of Diagnostic Investigation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Goswami SK, Ranjan P, Dutta RK, Verma SK. Management of inflammation in cardiovascular diseases. Pharmacol Res 2021; 173:105912. [PMID: 34562603 DOI: 10.1016/j.phrs.2021.105912] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 09/01/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality world-wide. Recently, the role of inflammation in the progression of diseases has significantly attracted considerable attention. In addition, various comorbidities, including diabetes, obesity, etc. exacerbate inflammation in the cardiovascular system, which ultimately leads to heart failure. Furthermore, cytokines released from specialized immune cells are key mediators of cardiac inflammation. Here, in this review article, we focused on the role of selected immune cells and cytokines (both pro-inflammatory and anti-inflammatory) in the regulation of cardiac inflammation and ultimately in cardiovascular diseases. While IL-1β, IL-6, TNFα, and IFNγ are associated with cardiac inflammation; IL-10, TGFβ, etc. are associated with resolution of inflammation and cardiac repair. IL-10 reduces cardiovascular inflammation and protects the cardiovascular system via interaction with SMAD2, p53, HuR, miR-375 and miR-21 pathway. In addition, we also highlighted recent advancements in the management of cardiac inflammation, including clinical trials of anti-inflammatory molecules to alleviate cardiovascular diseases.
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Affiliation(s)
- Sumanta Kumar Goswami
- Department of Medicine, Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Prabhat Ranjan
- Department of Medicine, Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Roshan Kumar Dutta
- Department of Medicine, Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Suresh Kumar Verma
- Department of Medicine, Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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Horowitz JM, Owyang C, Perman SM, Mitchell OJL, Yuriditsky E, Sawyer KN, Blewer AL, Rittenberger JC, Ciullo A, Hsu CH, Kotini-Shah P, Johnson N, Morgan RW, Moskowitz A, Dainty KN, Fleitman J, Uzendu AI, Abella BS, Teran F. The Latest in Resuscitation Research: Highlights From the 2020 American Heart Association's Resuscitation Science Symposium. J Am Heart Assoc 2021; 10:e021575. [PMID: 34369175 PMCID: PMC8475047 DOI: 10.1161/jaha.121.021575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Clark Owyang
- Department of Emergency Medicine and Division of Pulmonary and Critical Care Medicine Weill Cornell Medicine New York City NY
| | - Sarah M Perman
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Oscar J L Mitchell
- Division of Pulmonary and Critical Care Department of Medicine University of Pennsylvania Philadelphia PA
| | | | - Kelly N Sawyer
- Department of Emergency Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Audrey L Blewer
- Department of Family Medicine and Community Health Duke University Durham NC
| | - Jon C Rittenberger
- Guthrie-Robert Packer Hospital Emergency Medicine Residency Geisinger Commonwealth Medical College Sayre PA
| | - Anna Ciullo
- Division of Emergency Medicine Department of Surgery University of Utah Health Salt Lake City UT
| | - Cindy H Hsu
- Department of Emergency Medicine Department of Surgery Michigan Center for Integrative Research in Critical Care Michigan Medicine University of Michigan Ann Arbor MI
| | - Pavitra Kotini-Shah
- Department of Emergency Medicine University of Illinois College of Medicine at Chicago Chicago IL
| | - Nicholas Johnson
- Division of Pulmonary, Critical Care, & Sleep Medicine Department of Emergency Medicine University of Washington Seattle WA
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine at Children's Hospital of Philadelphia Philadelphia PA
| | - Ari Moskowitz
- Division of Critical Care Medicine Montefiore Medical Center Bronx, New York NY
| | - Katie N Dainty
- North York General Hospital University of Toronto Toronto Canada
| | - Jessica Fleitman
- Division of Cardiology University of Pennsylvania Philadelphia PA
| | - Anezi I Uzendu
- Division of Cardiology Massachusetts General Hospital Boston MA
| | - Benjamin S Abella
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
| | - Felipe Teran
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
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Meyer MAS, Wiberg S, Grand J, Meyer ASP, Obling LER, Frydland M, Thomsen JH, Josiassen J, Møller JE, Kjaergaard J, Hassager C. Treatment Effects of Interleukin-6 Receptor Antibodies for Modulating the Systemic Inflammatory Response After Out-of-Hospital Cardiac Arrest (The IMICA Trial): A Double-Blinded, Placebo-Controlled, Single-Center, Randomized, Clinical Trial. Circulation 2021; 143:1841-1851. [PMID: 33745292 PMCID: PMC8104015 DOI: 10.1161/circulationaha.120.053318] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. Patients experiencing out-of-hospital cardiac arrest who remain comatose after initial resuscitation are at high risk of morbidity and mortality attributable to the ensuing post–cardiac arrest syndrome. Systemic inflammation constitutes a major component of post–cardiac arrest syndrome, and IL-6 (interleukin-6) levels are associated with post–cardiac arrest syndrome severity. The IL-6 receptor antagonist tocilizumab could potentially dampen inflammation in post–cardiac arrest syndrome. The objective of the present trial was to determine the efficacy of tocilizumab to reduce systemic inflammation after out-of-hospital cardiac arrest of a presumed cardiac cause and thereby potentially mitigate organ injury.
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Affiliation(s)
- Martin Abild Stengaard Meyer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (M.A.S.M., S.W., J.G., A.S.P.M., M.F., J.H.T., J.J., J.E.M., J.K., C.H.)
| | - Sebastian Wiberg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (M.A.S.M., S.W., J.G., A.S.P.M., M.F., J.H.T., J.J., J.E.M., J.K., C.H.)
| | - Johannes Grand
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (M.A.S.M., S.W., J.G., A.S.P.M., M.F., J.H.T., J.J., J.E.M., J.K., C.H.)
| | - Anna Sina Pettersson Meyer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (M.A.S.M., S.W., J.G., A.S.P.M., M.F., J.H.T., J.J., J.E.M., J.K., C.H.)
| | | | - Martin Frydland
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (M.A.S.M., S.W., J.G., A.S.P.M., M.F., J.H.T., J.J., J.E.M., J.K., C.H.)
| | - Jakob Hartvig Thomsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (M.A.S.M., S.W., J.G., A.S.P.M., M.F., J.H.T., J.J., J.E.M., J.K., C.H.)
| | - Jakob Josiassen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (M.A.S.M., S.W., J.G., A.S.P.M., M.F., J.H.T., J.J., J.E.M., J.K., C.H.)
| | - Jacob Eifer Møller
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (M.A.S.M., S.W., J.G., A.S.P.M., M.F., J.H.T., J.J., J.E.M., J.K., C.H.).,Department of Cardiology, Odense University Hospital, Denmark (J.E.M.)
| | - Jesper Kjaergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (M.A.S.M., S.W., J.G., A.S.P.M., M.F., J.H.T., J.J., J.E.M., J.K., C.H.)
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (M.A.S.M., S.W., J.G., A.S.P.M., M.F., J.H.T., J.J., J.E.M., J.K., C.H.).,Department of Clinical Medicine, University of Copenhagen, Denmark (C.H.)
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