Plasma endothelin-1 level at the onset of ischemic ventricular fibrillation predicts resuscitation outcome.

Authors:	Atman P Shah, James T Niemann, Scott Youngquist, Ted Heyming, John P Rosborough
Language:	Eng.
Date:	2009-05-04
Journal:	Resuscitation (0300-9572)
Release:	Resuscitation. 2009 May;80(5):580-3
Abstract:	BACKGROUND: Endogenous vasopressors, including endothelin-1 (ET-1), have been shown to be elevated in patients following resuscitation from out-of-hospital cardiac arrest and are likely a physiologic response to global ischaemia. The importance of ET-1 in the setting of arrest and resuscitation has not been established. Prior work has demonstrated that ET-1 increases significantly after coronary occlusion. The purpose of this study was to assess changes in ET-1 following induction of ischaemia and VF. METHODS: VF was induced in 30 anesthetized and instrumented swine by balloon occlusion of the LAD. Blood was collected from the right atrium at baseline and at 5 min intervals following LAD occlusion until VF occurred. After 7 min of VF, resuscitation was attempted in accordance with guidelines. ET-1 and matrix metalloproteinase-9 (MMP-9), a measure of infarct size, were measured using ELISA. RESULTS: ET-1 and MMP-9 levels increased significantly from baseline within 20 min of occlusion of the LAD. Animals that could not be resuscitated had a higher ET-1 (p=0.031) at VF onset but similar ischaemia time (time to VF) and MMP-9, reflecting infarct size. An ET-1 level >4 pg/ml had a likelihood ratio of 4 for predicting resuscitation failure. CONCLUSIONS: Elevated levels of ET-1 during acute ischaemia predict resuscitation failure independent of the time to VF. This finding may be due to the known effect of ET-1 on coronary vascular resistance or ventricular compliance, resulting in early ischemic contracture.
Copyright:	Resuscitation Department of Medicine, Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, United States. ashah labiomed.org
Full text:	DOI - Resuscitation (DOI) EBSCO - HTML (needs subscription) Elsevier Science - HTML (needs subscription) OhioLINK Electronic Journal Center - HTML (needs subscription) Swets Information Services - HTML (needs subscription)
Terms:	Animals, Cardiopulmonary Resuscitation, Disease Models, Animal, Endothelin-1, Male, Matrix Metalloproteinase 9, Myocardial Ischemia, Predictive Value of Tests, Swine, Time Factors, Treatment Outcome, Ventricular Fibrillation