Abstract 238: Ability to Activate the Eicosanoid and Polyunsaturated Fatty Acid Pathways Predicts Survival After Cardiac Arrest
Background: Cardiac arrest (CA) and ROSC are associated with profound oxidative stress and systemic inflammation which is, in part, modulated by eicosanoid pathways. Docosahexaenoic acid (DHA) has anti-inflammatory properties, reduces cytokines, and is the precursor for D-resolvins and protectins which actively resolve inflammation. 5-Hydroxyeicosatetraenoic acid (5-HETE) is produced by the oxidation of arachadonic acid and is considered a “biomarker” of the inflammatory status of the body. It is linked to outcomes in trauma and sepsis.
Hypothesis: DHA and 5-HETE levels after ROSC will be associated with outcome after CA
Methods: Ninety-two pts from the 4 center Characterization of Mitochondrial Injury After Cardiac Arrest (COMICA) study had serial plasma samples analyzed for DHA and 5-HETE by mass spectroscopy at Time 0 (T0) upon arrival to the hospital, and 12, 24, 36, and 48 hours post ROSC. A repeated measures ANOVA was fit with a between subjects factor (Group: Survived, Expired), a within subjects factor (Time: 0, 12, 24, 38, 48) and the interaction between these two factors. Values are presented as mean ± SEM.
Results: The figure shows the relationship between 5-HETE and DHA, respectively, vs. time in pts who survived and died. There was a significant Group x Time interaction for both DHA and 5HETE (p=0.0055 and p=0.0016). Post-Hoc tests revealed that the T0 5HETE level was significantly higher in those who survived vs. expired (p = 0.0003). There was a strong trend (p=0.058) for the T0 DHA level to be higher in survivors.
Conclusions: Non-survivors have lower levels of 5-HETE and DHA than survivors immediately following hospital admission after ROSC from CA. Severe oxidative stress may deplete the lipid precursor pool. Survivors appear to have an intact polyunsaturated fatty acid system that is associated with recovery. Lipid biomarkers may serve as an early marker of outcome and potential area for therapeutic intervention after CA.
- © 2013 by American Heart Association, Inc.