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.
2009-05-04
Eng.
Resuscitation
Department of Medicine, Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, United States. ashah [at] labiomed.org
Resuscitation. 2009 May;80(5):580-3
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