Utility of Inflammatory Biomarkers for Predicting Organ Failure and Outcomes in Cardiac Arrest Patients

Abstract Background High-dose intravenous vitamin C directly scavenges and decreases the production of harmful reactive oxygen species (ROS) generated during ischemia/reperfusion after a cardiac arrest. The aim of this study is to investigate whether short-term treatment with a supplementary or very high-dose intravenous vitamin C reduces organ failure in post-cardiac arrest patients. Methods This is a double-blind, multi-center, randomized placebo-controlled trial conducted in 7 intensive care units (ICUs) in The Netherlands. A total of 270 patients with cardiac arrest and return of spontaneous circulation will be randomly assigned to three groups of 90 patients (1:1:1 ratio, stratified by site and age). Patients will intravenously receive a placebo, a supplementation dose of 3 g of vitamin C or a pharmacological dose of 10 g of vitamin C per day for 96 h. The primary endpoint is organ failure at 96 h as measured by the Resuscitation-Sequential Organ Failure Assessment (R-SOFA) score at 96 h minus the baseline score (delta R-SOFA). Secondary endpoints are a neurological outcome, mortality, length of ICU and hospital stay, myocardial injury, vasopressor support, lung injury score, ventilator-free days, renal function, ICU-acquired weakness, delirium, oxidative stress parameters, and plasma vitamin C concentrations. Discussion Vitamin C supplementation is safe and preclinical studies have shown beneficial effects of high-dose IV vitamin C in cardiac arrest models. This is the first RCT to assess the clinical effect of intravenous vitamin C on organ dysfunction in critically ill patients after cardiac arrest. Trial registration ClinicalTrials.gov NCT03509662. Registered on April 26, 2018. https://clinicaltrials.gov/ct2/show/NCT03509662European Clinical Trials Database (EudraCT): 2017-004318-25. Registered on June 8, 2018. https://www.clinicaltrialsregister.eu/ctr-search/trial/2017-004318-25/NL

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The Sequential Organ Failure Assessment (SOFA) score predicts mortality and neurological outcome in patients with post-cardiac arrest syndrome

Journal of Cardiology ◽

10.1016/j.jjcc.2020.03.007 ◽

2020 ◽

Vol 76 (3) ◽

pp. 295-302 ◽

Cited By ~ 1

Author(s):

Junji Matsuda ◽

Shunichi Kato ◽

Hirotaka Yano ◽

Giichi Nitta ◽

Toshikazu Kono ◽

...

Keyword(s):

Cardiac Arrest ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Sofa Score ◽

Neurological Outcome ◽

Failure Assessment ◽

Post Cardiac Arrest Syndrome

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The Burden of Co-Morbidities and Organ Failure Is Strongly Associated with Mortality After Intensive Care Unit Cardiac Arrest

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a3401 ◽

2019 ◽

Author(s):

D. Khateeb ◽

T. Bekker ◽

N. Zahustecher ◽

L. Tang ◽

J. Stout ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Organ Failure

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Epidemiology of intensive care unit cardiac arrest: Characteristics, comorbidities, and post-cardiac arrest organ failure — A prospective observational study

Resuscitation ◽

10.1016/j.resuscitation.2020.09.003 ◽

2020 ◽

Vol 156 ◽

pp. 92-98

Author(s):

Kevin Roedl ◽

Dominik Jarczak ◽

Rasmus Blohm ◽

Sarah Winterland ◽

Jakob Müller ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Observational Study ◽

Organ Failure ◽

Prospective Observational Study

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P6387Post-cardiac arrest syndrome (PCAS)-feasibility study. Impact of multi-organ failure on early prognosis

European Heart Journal ◽

10.1093/eurheartj/ehz746.0983 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Czerwinska ◽

J G Grand ◽

G T Tavazzi ◽

J S R Sans-Rosello ◽

A W Wood ◽

...

Keyword(s):

Cardiac Arrest ◽

Respiratory Failure ◽

Organ Failure ◽

Feasibility Study ◽

Sofa Score ◽

Predictive Value ◽

Early Mortality ◽

Risk Of Death ◽

Multi Organ Failure ◽

Post Cardiac Arrest Syndrome

Abstract Out-of hospital cardiac arrest (OHCA) of cardiac etiology is a leading cause of death in developed countries. Despite the improvement in rate of successfully resuscitated OHCA patients, their survival to discharge is generally poor. Multi-organ failure (MOF) due to post-cardiac arrest syndrome seems to be important in early prognostication after OHCA. Yet, the profile of organ failure and its prognostic value on early mortality after OHCA is unknown. The aim of the study was to perform a holistic analysis of MOF and its impact on early prognosis in patients after OHCA due to cardiac causes. Methods Post-cardiac arrest syndrome (PCAS)–feasibility study, was a multicenter, international project approved and endorsed by the Acute Cardiovascular Care Association (ACCA) lead by doctors associated with the Young ACC Community (YAC3). Inclusion criteria were: OHCA primarily due to cardiac causes, admission to ACCA center after ROSC. Criterion for feasibility was to recruit 100 pts within 12 months from the beginning of the study. Organ function parameters were assessed on admission, than every 24h, until 72h of stay. MOF was defined according to Sequential Organ Failure Assessment (SOFA) score & modified ADRS Berlin definition. Follow-up was 30-days. Primary end points were in-hospital and 30-day mortality. For statistical analysis Fisher exact test, non-parametric Mann–Whitney U test, and logistic regression were used. All p-values <0.05 were considered as statistically significant. Results Six ACCA centers participated in the project (Poland-2,Denmark-1,Spain-1,Italy-1,UK-1). Overall, 148 pts (age 62.9±15.27yrs; 27% female) were included. Main cause of OHCA was ACS 67 (45.27%), the most frequent initial rhythm was ventricular fibrillation VF 101 (68.24%). Median time to ROSC was 25 (15–35) min. In-hospital and 30 day mortality was 68 (46.9%) and 4 (5.33%), respectively. MOF with SOFA score ≥7 (high-risk of death) was noted in 100 (67.6%)pts at admission, and between 70 (59.82%) – 98 (74.8%)pts, thereafter. At least moderate respiratory failure was noted in 60 (42.5%)pts at admission, and between 10 (11%) – 37 (31%)pts, thereafter. SOFA score (Fig.1), respiratory failure at 24h (p=0.006) and 48h (p=0.013) after admission were positively correlated with in-hospital mortality. Early MOF expressed with SOFA score predicted the risk of 30-day mortality, with the strongest predictive value at 72h from admission OR 1.53 95% CI (1.29–1.82); p<0.001. Similarly, early respiratory failure predicted 30-day mortality, with the strongest predictive value at 24h of assessment OR 2.29 95% CI (1.44–3.66); p<0.001. SOFA score & mortality after OHCA Conclusions Patients after OHCA due to cardiac causes have a high-rate of MOF with high mortality early after the event. Those patients who survive to discharge have a relatively low 30-day mortality Multi-organ failure may predict early mortality after OHCA due to cardiac causes.

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COAGULOPATHY AND MULTIPLE ORGAN FAILURE AFTER TRAUMATIC EXSANGUINATION CARDIAC ARREST (CA) OF 60 MIN IN DOGS

Critical Care Medicine ◽

10.1097/00003246-200212001-00411 ◽

2002 ◽

Vol 30 (Supplement) ◽

pp. A120 ◽

Cited By ~ 2

Author(s):

A Nozari ◽

F Bontempo ◽

P Safar ◽

X Wu ◽

S W Stezoski ◽

...

Keyword(s):

Cardiac Arrest ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ

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Epidemiological Trends in the Timing of In-Hospital Death in Acute Myocardial Infarction-Cardiogenic Shock in the United States

Journal of Clinical Medicine ◽

10.3390/jcm9072094 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2094 ◽

Cited By ~ 3

Author(s):

Saraschandra Vallabhajosyula ◽

Shannon M. Dunlay ◽

Malcolm R. Bell ◽

P. Elliott Miller ◽

Wisit Cheungpasitporn ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Cardiogenic Shock ◽

Organ Failure ◽

The United States ◽

Hospital Death ◽

Do Not Resuscitate ◽

St Segment Elevation ◽

St Segment

Background: There are limited data on the epidemiology and timing of in-hospital death (IHD) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS). Methods: Adult admissions with AMI-CS with IHDs were identified using the National Inpatient Sample (2000–2016) and were classified as early (≤2 days), mid-term (3–7 days), and late (>7 days). Inter-hospital transfers and those with do-not-resuscitate statuses were excluded. The outcomes of interest included the epidemiology, temporal trends and predictors for IHD timing. Results: IHD was noted in 113,349 AMI-CS admissions (median time to IHD 3 (interquartile range 1–7) days), with early, mid-term and late IHD in 44%, 32% and 24%, respectively. Compared to the mid-term and late groups, the early IHD group had higher rates of ST-segment-elevation AMI-CS (74%, 63%, 60%) and cardiac arrest (37%, 33%, 29%), but lower rates of acute organ failure (68%, 79%, 89%), use of coronary angiography (45%, 56%, 67%), percutaneous coronary intervention (33%, 36%, 42%), and mechanical circulatory support (31%, 39%, 50%) (all p < 0.001). There was a temporal increase in the early (adjusted odds ratio (aOR) for 2016 vs. 2000 2.50 (95% confidence interval (CI) 2.22–2.78)) and a decrease in mid-term (aOR 0.75 (95% CI 0.71–0.79)) and late (aOR 0.34 (95% CI 0.31–0.37)) IHD. ST-segment-elevation AMI-CS and cardiac arrest were associated with the increased risk of early IHD, whereas advanced comorbidity and acute organ failure were associated with late IHD. Conclusions: Early IHD after AMI-CS has increased between 2000 and 2016. The populations with early vs. late IHD were systematically different.

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Ubiquitous protective effects of cyclosporine A in preventing cardiac arrest-induced multiple organ failure

Journal of Applied Physiology ◽

10.1152/japplphysiol.00495.2014 ◽

2014 ◽

Vol 117 (8) ◽

pp. 930-936 ◽

Cited By ~ 15

Author(s):

Martin Cour ◽

Maryline Abrial ◽

Vincent Jahandiez ◽

Joseph Loufouat ◽

Elise Belaïdi ◽

...

Keyword(s):

Cardiac Arrest ◽

Multiple Organ Failure ◽

Organ Failure ◽

Brain Damage ◽

Cyclosporine A ◽

Myocardial Dysfunction ◽

Permeability Transition ◽

Multiple Organ ◽

Term Survival ◽

Kidney Liver

Opening of the mitochondrial permeability transition pore (mPTP) appears to be a pivotal event in myocardial ischemia-reperfusion (I/R) injury. Resuscitated cardiac arrest (CA) leads to the post-CA syndrome that encompasses, not only myocardial dysfunction, but also brain injury, failure of other organs (kidney, liver, or lung), and systemic response to I/R. We aimed to determine whether cyclosporine A (CsA) might prevent multiple organ failure following CA through a ubiquitous mPTP inhibition in each distant vital organ. Anesthetized New Zealand White rabbits were subjected to 15 min of CA and 120 min of reperfusion. At the onset of resuscitation, the rabbits received CsA, its non-immunosuppressive derivative NIM811, or vehicle (controls). Survival, hemodynamics, brain damage, organ injuries, and systemic I/R response were analyzed. Fresh mitochondria were isolated from the brain, heart, kidney, liver, and lung to assess both oxidative phosphorylation and permeability transition. CsA analogs significantly improved short-term survival and prevented multiple organ failure, including brain damage and myocardial dysfunction ( P < 0.05 vs. controls). Susceptibility of mPTP opening was significantly increased in heart, brain, kidney, and liver mitochondria isolated from controls, while mitochondrial respiration was impaired ( P < 0.05 vs. sham). CsA analogs prevented these mitochondrial dysfunctions ( P < 0.05 vs. controls). These results suggest that CsA and NIM811 can prevent the post-CA syndrome through a ubiquitous mitochondrial protective effect at the level of each major distant organ.

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