Abstract 2275: “Proinflammatory Cytokine Storm” Follows Early Reperfusion After Resuscitation From Prolonged Ischemia-Associated VF Arrest in Swine
Background: Proinflammatory cytokines have been reported to increase in resuscitated patients. These stress-activated cytokines may play a role in early and overall long-term outcome. We hypothesized that proinflammatory cytokines, released in response to ischemia, increase following resuscitation and affect early postresuscitation cardiac function.
Methods: Ischemic VF was induced in 17 swine following balloon occlusion of the LAD. The balloon remained inflated during resuscitation efforts. After 7 min of VF, CPR was initiated and countershocks, epinephrine, and antiarrhythmics administered as per guidelines. Resuscitation was terminated if ROSC had not occurred after 15 min of ACLS. TNF-α, IL-1β, and IL-6 (ELISA) were measured at 15 minutes in all animals and during the early reperfusion period (15, 30, 60 min after ROSC) and then at hourly intervals for 6 hours in resuscitated animals. The LAD balloon was deflated at 60 min. Hemodynamic data were recorded and LV stroke work calculated.
Results: Findings are summarized in the figure⇓. Values are the mean ± SE. Differences were assessed with one-way RM ANOVA (*p<0.05 TNF and #p<0.05 IL-1 v control). LV function (stroke work) was significantly (p<0.01 vs control) depressed at all time points. IL-6 concentrations also increased but failed to attain significant differences at study times due to elevated control levels in only the females.
Conclusion: 1. TNF-α increases during early reperfusion but returns to prearrest values within 90 min; a significant rise in IL-1β occurs later. 2. These cytokines are associated with depression of LV function. 3. IL-6 also increases but the rise may be affected by prearrest levels and gender.