Abstract 97: Elevated Circulating Microparticles in Patients After Successful Cardiopulmonary Resuscitation
Background: Ischemia and reperfusion after cardiopulmonary resuscitation (CPR) induce endothelial activation, systemic inflammatory response and initiation of coagulation leading to post-resuscitation disease. Microparticles (MPs) are small vesicles shed from the plasma membrane by cells undergoing activation or apoptosis. Monocyte-derived MPs (MMPs) and platelet-derived MPs (PMPs) are involved in the adherence of neutrophils to the endothelium. Endothelial MPs (EMPs) can interact with monocytes (EMP-MC) and platelets (EMP-PC) to form circulating conjugates. To evaluate these sensitive markers of inflammation, endothelial activation and coagulation in post-resuscitation disease, we analyzed different MPs and their conjugates in resuscitated patients.
Material and methods: A total of 38 patients after successful CPR were included and compared to 20 control patients with stable coronary artery disease (CAD). Blood samples for analysis were drawn in the first 2–3 hours and 24 hours after restoration of spontaneous circulation (ROSC), or after coronary angiography in controls, respectively. All measurements were performed by flow cytometric analysis.
Results: Immediately after CPR MMPs (2.2±0.4 vs. 0.3±0.1 events/μl; p<0.001) and EMP-MC (2.9±0.9 vs. 1.0±0.2 events/μl; p<0.05) were significant elevated compared to controls, persisting 24 hours after ROSC (MMPs: 2.2±0.8 vs. 0.5±0.2 events/μl; p<0.05; EMP-MC: 3.0±0.8 vs. 1.5±0.5 events/μl; p<0.05). PMPs were higher immediately after CPR compared to CAD, but did not reach significance until 24 hours after ROSC (67.9±25.6 vs. 11.3±1.7 events/μl; p<0,05). EMP-PC were significantly lowered immediately after CPR (23.4±3.3 vs. 43.4±7.8 events/μl; p<0,05) compared to controls.
Conclusions: Patients after CPR show substantially altered levels of different MPs and their conjugates immediately and 24 hours after ROSC, suggesting an early onset of inflammation, an ongoing process of endothelial activation, and a procoagulatory state, leading to disturbed microcirculation. These results suggest an involvement of MPs in the development of the post-resuscitation disease.
- © 2010 by American Heart Association, Inc.