Abstract 18677: Correlation of Cytokine Levels After Cardiac Arrest With Clinical Outcomes and Brain Regional Saturation of Oxygen (rSO2)
Introduction: The Post Cardiac Arrest syndrome (PCAS) cytokine storm is associated with mortality and neurological deficits. The magnitude of PCAS cytokine storm reflects the ischemic burden during CPR. We have demonstrated that increasing regional cerebral oxygenation (rSO2) levels during CPR are associated with ROSC and survival with favorable neurological outcomes.
Hypothesis: We hypothesize that higher rSO2 levels lead to improved CA outcomes by limiting ischemia, which in turn attenuates post resuscitation reperfusion injury and cytokine storm.
Methods: 26 ICU subjects had serum collected within 6hrs (t=0) and at 24 hrs after ROSC (day 1). We used a multiplex analysis to measure 34 cytokines including ILs 2, 8, 10, 11 ,12, Pentraxin, Interferons α , β and γ and soluble IL6 Receptor A (sIL6RA). rSO2 levels were collected during CPR (Nonin Equanox). We used a Pearson’s correlation and t-test to measure the association between rSO2 and post resuscitation cytokine release, as well as differences in cytokine levels in post-resuscitation subjects who survived to discharge with a favorable neurological outcome cerebral performance category (CPC) 1-2 vs. CPC 3-5 (death or severe neurological injury)
Results: 14 of 26 (54%) patients had CPC3-5. There were no differences between CPC 1-2 vs CPC3-5 with respect to location, age, gender, or duration of CPR. There was a significant inverse relationship between rSO2 levels during CPR and post resuscitation sIL6RA (r=-0.8 p 0.003); Interferon (IFN) α2 (r=-0.79 p 0.006); IFN γ (r=-0.64 p 0.045); IL-19 (r=-0.86 p 0.01); IL20 (r=-0.85 p 0.001); IL35 (r=-0.70 p 0.02) and TWEAKTNF12 (r=-0.72 p 0.01) at t=0. We identified a significant difference between CPC 1-2 v 3-5 at day 0 for IL-10 (p 0.01), Pentraxin and sTNFR1(p<0.05) and between IL-10 (p 0.05), Pentraxin-3 (p 0.003), IFN γ (p 0.003), IL-22 (p 0.02) and sCD163 (p 0.01) at day 1.
Conclusions: The magnitude of PCAS cytokine storm may be attenuated by higher cerebral O2 delivery during CPR.
Author Disclosures: N. Sinha: None. V. Chabra: None. S.T. Ravishankar: None. R.T. Nguyen: None. B.A. Suarez: None. C. O’Neill: None. D. Gnatenko: None. H.C. Thode: None. S. Parnia: None.
- © 2016 by American Heart Association, Inc.