1 During and after cardiopulmonary resuscitation, activation of blood coagulation, 2,3 platelet activation with formation of thromboxane A 2, 4 and an alteration of soluble E-selectin and P-selectin 5 have been described. The prognosis of survival in patients with out-of-hospital cardiac arrest (OHCA) remains poor, ranging from 4% to 33%, essentially depending on the organization of the chain of survival. Finally, using in vitro plasma exchange between healthy control subjects and patients, we demonstrated that the endotoxin-dependent hyporeactivity was an intrinsic property of patients’ leukocytes and that an immunosuppressive activity was also present in their plasma.Ĭonclusions- Altogether, the high levels of circulating cytokines, the presence of endotoxin in plasma, and the dysregulated production of cytokines found in these patients recall the immunological profile found in patients with sepsis. The productions of T-cell–derived IL-10 and interferon-γ were also impaired in these patients.
In contrast, IL-1 receptor antagonist productions were enhanced in these patients compared with healthy control subjects. Endotoxin-induced TNF and IL-6 productions were dramatically impaired in these patients compared with healthy control subjects, whereas an unaltered production was observed with heat-killed Staphylococcus aureus. Plasma endotoxin was detected in 46% of the analyzed patients within the 2 first days. Among nonsurvivors, the initial need for a vasopressor agent was associated with higher levels of IL-1 receptor antagonist, IL-10, and IL-6 on day 1. On admission, high levels of plasma interleukin (IL)-6, IL-8, IL-10, and soluble tumor necrosis factor (TNF) receptor type II could discriminate between survivors and nonsurvivors. Methods and Results- Plasma cytokine, endotoxin, and ex vivo cytokine production in whole-blood assays was assessed in 61, 35, and 11 patients, respectively.
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