| Infliximab attenuates early myocardial dysfunction after resuscitation in a swine cardiac arrest model. | |
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MedLine Citation:
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PMID: 20154606 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Left ventricular dysfunction after successful cardiopulmonary resuscitation contributes to early death after resuscitation. Proinflammatory cytokines are known to decrease myocardial function, and tumor necrosis factor-alpha has been shown to increase after successful resuscitation. We hypothesized that blocking the effects of tumor necrosis factor-alpha with infliximab would prevent or minimize postresuscitation cardiac dysfunction. DESIGN: Randomized, placebo-controlled comparative study. SETTING: Large animal research laboratory. SUBJECTS: Twenty-eight anesthetized and instrumented domestic male swine (Yorkshire and Yorkshire/Hampshire mix; weight, 35-45 kg). INTERVENTIONS: Infusion of infliximab (5 mg/kg) or normal saline after resuscitation from ventricular fibrillation cardiac arrest. MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables, indices of left ventricular function, and tumor necrosis factor-alpha were measured before and after 8 mins of cardiac arrest during the early postresuscitation period (3 hrs). Within 5 mins of restoration of spontaneous circulation, 14 animals received infliximab, 5 mg/kg, infused over 30 mins. Fourteen animals received an infusion of normal saline. Inotropes and vasopressors were not administered to either group after resuscitation. Tumor necrosis factor-alpha increased after restoration of circulation and remained elevated throughout the observation period. Differences between groups were not significant. Interleukin-1beta concentration did not change significantly during the observation period in either study group. Mean arterial pressure and stroke work were significantly greater in the infliximab group within 30 mins of resuscitation, and these differences were sustained throughout the 3-hr postresuscitation period. The effect of tumor necrosis factor-alpha blockade was evident only in animals with a significant increase (doubling) in plasma tumor necrosis factor-alpha at 30 mins after arrest. CONCLUSION: Tumor necrosis factor-alpha plays a role in cardiac dysfunction after arrest and infliximab may attenuate or prevent postresuscitation myocardial dysfunction when administered immediately after resuscitation. |
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Authors:
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James T Niemann; Scott Youngquist; John P Rosborough; Atman P Shah; Quynh T Phan; Scott G Filler |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Critical care medicine Volume: 38 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-25 Completed Date: 2010-04-09 Revised Date: 2011-07-27 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1162-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA. jniemann@emedharbor.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Anti-Inflammatory Agents Antibodies, Monoclonal / therapeutic use* Cardiopulmonary Resuscitation* Disease Models, Animal Heart / drug effects, physiopathology* Heart Arrest / drug therapy*, physiopathology Hemodynamics / drug effects, physiology Interleukin-1beta / blood Male Swine Tumor Necrosis Factor-alpha / antagonists & inhibitors, blood |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL076671/HL/NHLBI NIH HHS; R01 HL076671-03/HL/NHLBI NIH HHS; R01 HL076671-04/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anti-Inflammatory Agents; 0/Antibodies, Monoclonal; 0/Interleukin-1beta; 0/Tumor Necrosis Factor-alpha; 0/infliximab |
| Comments/Corrections | |
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