Abstract 13162: Post-Cardiac Arrest Serum TNF-α Levels Are Associated With Short-Term Survival in a Swine Model of Ventricular Fibrillation
Introduction: Most resuscitated victims of out-of-hospital cardiac arrest who survive to hospital expire due to the post-resuscitation syndrome. This syndrome is characterized by a sepsis-like pro-inflammatory state.
Hypothesis: We hypothesized that a relationship exists between the rise of TNF-α, a pro-inflammatory cytokine, following return of spontaneous circulation (ROSC) and early post-arrest survival in a clinically relevant animal model of spontaneous VF.
Methods: Mixed-breed Yorkshire swine (n=20), weighing 39 +5 kg, were anesthetized and catheters placed in the right atrium and left ventricle/ascending aorta for continuous pressure monitoring. VF was induced by occluding the LAD with an angioplasty balloon. After 7 min of untreated VF, ALS resuscitation attempts were made for up to 20 min. Animals achieving ROSC were monitored for 3 hrs and fluid and pressor support was administered as needed. TNF-α levels were measured prior to VF and at 0, 15, and 30 min after ROSC using quantitative sandwich ELISA. Exact logistic regression and binomial proportions were used for analysis.
Results: Twelve (60%) animals experienced early death, expiring during the 3-hour post-arrest period (9 PEA, 2 VF, and 1 asystole). The TNF-α level at 15 minutes post-ROSC was significantly associated with death within the first 3 hours post ROSC with a univariate odds ratio (OR) of 1.4 (95% confidence interval [CI] 1.05-2.2, p=0.01). Using a cutoff TNF-α level of 525 pg/mL at 15 min post ROSC had 100% negative predictive value (95% CI 0-37%) and 67% positive predictive value (95% CI 35-90%) for early death.
Conclusions: The pro-inflammatory cytokine TNF-α increases shortly after ROSC and is predictive of early death. Early identification of resuscitated victims at greatest risk for hemodynamic collapse and recurrent arrest might facilitate the use of early hospital-based interventions to decrease the likelihood of a poor outcome.
Author Disclosures: S. Youngquist: None. A. Shah: None. J. Rosborough: None. J.T. Niemann: None.
- © 2015 by American Heart Association, Inc.