Abstract P179: Severe Endothelial Injury in Patients After Successful Cardiopulmonary Resuscitation
Background: Ischemia and reperfusion after cardiopulmonary resuscitation (CPR) induce endothelial activation and systemic inflammatory response leading to post-resuscitation disease, a condition of multiple life-threatening disorders related to whole-body ischemia and reperfusion syndrome. In this experimental study we analyzed direct markers of endothelial damage and regeneration in patients after successful cardiac arrest for non traumatic causes.
Methods: A total of 58 patients after successful CPR were included and compared to 41 control patients with stable coronary artery disease (CAD). Blood samples for analysis were drawn in the first 2–3 hours and 24 hours after ROSC or after PCI in controls respectively. Enumeration of circulating endothelial cells (CEC), endothelial microparticles (EMP) and endothelial progenitor cells (EPC) was performed by flow cytometric analysis. Von Willebrand factor (vWF) was assessed by ELISA-test.
Results: There was a massive raise in CEC count in resuscitated patients compared to controls (4494,1±5278 vs. 320±142,5 cells/mL; p<0,001). Patients after prolonged CPR (≥30min) showed elevated numbers of CEC compared to those resuscitated less than 30min (6196,2±6898,1 vs. 2340,9±1989,9 cells/mL; p=0,14/ns). There was a significant positive correlation of CEC count with duration of CPR (R2=0,84; p<0,01). Numbers of EMP were higher immediately after CPR compared to controls (5608,8±5760,6 vs. 3537,6±2097,6 gated events; p=0,31) but did not reach significance until 24 hours after CPR (12433,3±9740,6 vs. 3986,8±2094,7 gated events; p<0,005). Rise in CEC and EMP in resuscitated patients is paralleled by significantly elevated plasma levels of vWF compared to controls (304,4±120,5%; normal range 50–160%, p<0,001). EPC were also significant elevated in resuscitated patients compared to controls (0,13±0,07 vs. 0,66±0,61% p<0,05).
Conclusions: Numbers of CEC and EMP are substantially elevated in patients after CPR showing a generalized endothelial damage. A further rise in EMP in the first 24 hours after ROSC reflects an ongoing process of endothelial damage. Rise in EPC on the second day after CPR indicates an early onset of endothelial repair.