Abstract 15995: Etiology and Outcomes Associated With Endothelial Dysfunction in Post Cardiac Arrest Patients

• Published in: Circulation (New York, N.Y.) N.Y.), 2015-11, Vol.132 (Suppl_3 Suppl 3), p.A15995-A15995
• Main Authors: Gidwani, Hitesh V, Coppler, Patrick, Rattan, Rohit, Rahman, Riaz, Shashidharan, Shiva, Darwin, Andrew, Adams, Peter, Taft, Maia, Airgood, Hannah, Elmer, Jonathan, Dezfulian, Cameron
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.132.suppl_3.15995

BackgroundEndothelial dysfunction (ED) may occur after cardiac arrest (CA) both due to the underlying patient comorbidities which result in CA and the global ischemia-reperfusion which results. The prevalence of ED after CA is poorly characterized as is any association with outcomes.HypothesisED will be more common in asphyxial arrests, after prolonged CPR times and in subjects with multiple coronary artery risk factors. ED will associate with worsened outcomes.MethodsProspective, observational study of 23 CA with return of spontaneous circulation (ROSC) expected to live >48 h. ED was assessed at 0-6 hours and at 36-48 hours after ROSC using measurements of plasma nitrite (n=14) or laser speckle contrast imaging (LSCI) (n=13) before and after 6 min vaso-occlusion (VO) of forearm blood flow. VO was achieved using a blood pressure cuff inflated at 200 mm Hg. LSCI quantified blood flow at baseline (pre-VO), during ischemia (trough), upon reperfusion (hyperemia peak) and 5 min later (nadir). LSCI values were all normalized to pre-VO baseline. Plasma nitrite was measured before after VO. Plasma nitrite was quantified by reductive chemiluminescence. ED is known to result in lower plasma nitrite and reduced post-VO hyperemia and nadir. Data was gathered on patient comorbidities, CA characteristics and outcomes and means compared by Mann Whitney U for dichotomous variables and Spearman correlation for continuous variables.ResultsLower ischemic trough and reperfusion nadir were associated with unfavorable features and outcomes (Table). No patient factors were associated ED. LSCI nadir at 0-6 hrs correlated with CPR duration (r = -0.7, p =0.01) and trough correlated with number of CPR epinephrine doses (r= -0.7, p = 0.01). Plasma nitrite levels were similar in all comparisons.ConclusionsLSCI features characteristic of ED were more often noted with prolonged and asphyxial, non-VF CA rather than patient factors and were associated with worsened outcome.