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. 2009 May;80(5):580-3.
doi: 10.1016/j.resuscitation.2009.02.004. Epub 2009 Apr 10.

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

Atman P Shah  1 , James T Niemann, Scott Youngquist, Ted Heyming, John P Rosborough
Affiliations

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

Atman P Shah et al. Resuscitation. 2009 May.

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.

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Conflict of interest statement

Conflicts of Interest All the authors declare that there are no financial and personal relationships with other people or organisations that could inappropriately influence or bias their work.

Figures

Figure 1
Figure 1. Plasma Endothelin-1 Concentrations After LAD Occlusion
Plasma endothelin-1 was measured prior to coronary occlusion (time = 0) and at 5 min intervals until spontaneous ventricular fibrillation occurred. Differences were not noted between groups at any time point. ET-1 was significantly greater (p < 0.05) than baseline values at the 20, 25, and 30 min time points.
Figure 2
Figure 2. Plasma MMP-9 Concentrations After LAD Occlusion
Plasma MMP-9 was measured prior to coronary occlusion (time = 0) and at 5 min intervals until spontaneous ventricular fibrillation occurred. Differences were not noted between groups at any time point. MMP-9 was significantly greater (p < 0.05) than baseline values at the 20, 25, and 30 min time points.
Figure 3
Figure 3. Endothelin-1 Level versus Resuscitation Outcome
Peak ET-1 concentration preceding spontaneous VF and outcome are plotted for each study animal. A concentration of >4 pg/ml yielded a likelihood ratio of 4 for resuscitation failure.
See this image and copyright information in PMC

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