Assuntos
Serviços Médicos de Emergência , Gases Nobres/farmacologia , Síndrome Pós-Parada Cardíaca/tratamento farmacológico , Terapia Respiratória/métodos , Animais , Argônio/farmacologia , Argônio/uso terapêutico , Monóxido de Carbono/farmacologia , Monóxido de Carbono/uso terapêutico , Modelos Animais de Doenças , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Hélio/farmacologia , Hélio/uso terapêutico , Humanos , Hidrogênio/farmacologia , Hidrogênio/uso terapêutico , Sulfeto de Hidrogênio/farmacologia , Sulfeto de Hidrogênio/uso terapêutico , Óxido Nítrico/farmacologia , Óxido Nítrico/uso terapêutico , Gases Nobres/uso terapêutico , Síndrome Pós-Parada Cardíaca/fisiopatologia , Terapia Respiratória/normas , Terapia Respiratória/estatística & dados numéricos , Xenônio/farmacologia , Xenônio/uso terapêuticoRESUMO
Sudden cardiac arrest is a leading cause of death worldwide. Although the methods of cardiopulmonary resuscitation have been improved, mortality is still unacceptably high, and many survivors suffer from lasting neurological deficits due to the post-cardiac arrest syndrome (PCAS). Pathophysiologically, generalized vascular endothelial dysfunction accompanied by platelet activation and systemic inflammation has been implicated in the pathogenesis of PCAS. Because endothelial-derived nitric oxide (NO) plays a central role in maintaining vascular homeostasis, the role of NO-dependent signaling has been a focus of the intense investigation. Recent preclinical studies showed that therapeutic interventions that increase vascular NO bioavailability may improve outcomes after cardiac arrest complicated with PCAS. In particular, NO inhalation therapy has been shown to improve neurological outcomes and survival in multiple species. Clinical studies examining the safety and efficacy of inhaled NO in patients sustaining PCAS are warranted.
Assuntos
Fármacos Cardiovasculares/administração & dosagem , Doadores de Óxido Nítrico/uso terapêutico , Óxido Nítrico/administração & dosagem , Síndrome Pós-Parada Cardíaca/tratamento farmacológico , Administração por Inalação , Animais , Humanos , Óxido Nítrico/metabolismo , Síndrome Pós-Parada Cardíaca/metabolismo , Síndrome Pós-Parada Cardíaca/fisiopatologia , Resultado do TratamentoRESUMO
OBJECTIVE: An increasingly recognized prognostic factor for out-of-hospital-cardiac-arrest (OHCA) patients is the ischemia-reperfusion injury after restored blood circulation. Endothelial injury is common in patients resuscitated from cardiac arrest and is associated with poor outcome. This study was designed to investigate if iloprost infusion, a prostacyclin analogue, reduces endothelial damage in OHCA patients. METHODS: 50 patients were randomized in a placebo controlled double-blinded trial and allocated 1:2 to 48-hours iloprost infusion, (1 ng/kg/min) or placebo (saline infusion). Endothelial biomarkers (soluble thrombomodulin (sTM), sE-selectin, syndecan-1, soluble vascular endothelial growth factor (sVEGF), vascular endothelial cadherine (VEcad), nucleosomes) and sympathoadrenal activation (epinephrine/norepinephrine) from baseline to 48 and 96-hours were evaluated. RESULTS: Iloprost infusion did not influence endothelial biomarkers by the 48-hour endpoint. A rebound effect was observed with higher biomarker plasma values in the iloprost group (sTM p=0.02; Syndecan p=0.004; nucleosomes p<0.001; VEcad p<0.03) after 96-hours. There was a significant difference in 180-day mortality in favor of placebo. There was no difference regarding total adverse events between groups (p=0.73). Two patients were withdrawn in the iloprost group due to hypotension. CONCLUSIONS: The administration of low-dose iloprost (1ng/kg/min) to OHCA patients did not significantly influence endothelial biomarkers as measured by the 48- hour endpoint. A rebound effect was however observed in the 96-hour statistical model, with increasing endothelial biomarker levels after cessation of the iloprost-infusion.