| TNF-α Blockade Improves Early Post-Resuscitation Survival and Hemodynamics in a Swine Model of Ischemic Ventricular Fibrillation. | |
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MedLine Citation:
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PMID: 22683946 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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AIM OF THE STUDY: : Inflammatory cytokines have been implicated in the pathophysiology of post cardiac arrest syndrome, including myocardial dysfunction and hypotension, often leading to multi-organ system dysfunction and death. We hypothesized that administration of infliximab after return of spontaneous circulation (ROSC) would ameliorate hypotension and myocardial dysfunction and prolong survival. METHODS: Domestic swine were anesthetized and instrumented. Balloon occlusion of the LAD coronary artery just distal to the first septal perforator was performed and VF followed spontaneously in all animals. After 7min, chest compressions, defibrillation, and standard ACLS resuscitation was performed. Animals achieving ROSC (N=32) were randomized to receive infliximab (5mg/kg, n=16) or vehicle (250mL normal saline, n=16) immediately post-ROSC and survival and hemodynamics were monitored for 3hours. RESULTS: There were no differences in prearrest hemodynamic variables, TNF-α levels, or resuscitation variables between groups. Both groups demonstrated a time dependent decline in mean arterial pressure (MAP) and stroke work (SW) post-ROSC with a nadir at 1hour followed by recovery over hours 2 and 3. This decline was blunted in infliximab-treated swine (1-hour between group difference in MAP 21mmHg, 95% CI 3-38mmHg and SW 6.7 gm-m, 95% CI 0.4-13 at 1hour). Left ventricular systolic dp/dt fell in the vehicle group (-437mm Hg/sec, 95% CI -183 to -690) but did not in the infliximab group. Tau rose only in the vehicle group (44 msec, 95% CI 1-87). Short-term survival was higher in the infliximab group (Kaplan-Meier p=0.022). CONCLUSIONS: Blockade of TNF-α in the immediate post-ROSC period improved survival and hemodynamic parameters in this swine model of ischemic VF. |
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Authors:
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James T Niemann; Scott T Youngquist; Atman P Shah; Joseph L Thomas; John P Rosborough |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-6-7 |
Journal Detail:
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Title: Resuscitation Volume: - ISSN: 1873-1570 ISO Abbreviation: - Publication Date: 2012 Jun |
Date Detail:
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Created Date: 2012-6-11 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0332173 Medline TA: Resuscitation Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012. Published by Elsevier Ireland Ltd. |
Affiliation:
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The David Geffen School of Medicine at UCLA, Los Angeles, CA; The Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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