Abstract 18940: Pre-B-Cell Colony Enhancing Factor Blood Levels Correlate With Intravenous Catecholamine Use and Post-Resuscitation Death After Out-of-Hospital Cardiac Arrest
Introduction: High blood concentrations of the cytokine PBEF are associated with poor cardiac arrest outcomes in our prior animal studies. Furthermore, PBEF release results from high energy demands as occur with surges of catecholamine, and can cause cardiac dysfunction and up-regulation of other pro-inflammatory cytokines similar to that seen after human cardiac arrest.
Hypothesis: PBEF level is associated with cardiac arrest survival and intravenous catecholamine (i.e. CAT) administration.
Methods: Prospective, observational cohort study of 81 out-of-hospital cardiac arrest (OHCA) patients was performed at four geographically distinct urban tertiary care cardiac arrest centers of excellence from 2011 to 2012. Hypothermia (33°C) was applied to all patients. Intravenous CAT was administered per resuscitation protocols. Serial blood samples were taken at time of admission and through 48 h after admission (T0, T12, T24, T36 and T48 respectively). Survival and discharge outcomes with neurological score were evaluated.
Results: 75 patients had CAT administration and 36 patients did not. 25 out of 75 patients who received intravenous CAT survived. By contrast, 26 out of the 36 patients without CAT administration survived. Chi-square testing shows a strong association (33.3% vs. 72.2%, p=0.00012) between CAT treatment and death. A trend of high blood PBEF levels was observed throughout T0 to T48 with the T12 and T24 post-resuscitation time-points being most significant (p<0.05). In addition, higher PBEF levels were detected in patients who received intravenous CAT and died. A mixed model analysis showed that PBEF levels and CAT administration were independent factors related to post-resuscitation death. Death was also related to higher supplemental oxygen FiO2 (p<0.05), prolonged hypotension (p<0.05), lower oxygen saturation (p<0.05) and past history of diabetes, with marginal association with age (p = 0.054). There was no association race, gender, or BMI.
Conclusion: High blood PBEF levels and catecholamine administration are independently associated with post-resuscitation death in OHCA patients. Future work is needed to understand whether PBEF may an important mediator of catecholamine-induced post-resuscitation injury.
- Cardiac arrest
- Post cardiac resuscitation
- Drug administration
- Inflammation and inflammatory markers
Author Disclosures: J. Li: None. W. Zhang: None. X. Zhu: None. C. Lee: None. M.A. Peberdy: None. T.L. Vanden Hoek: None.
- © 2016 by American Heart Association, Inc.