OBJECTIVES: We investigated coagulation abnormalities in out-of-hospital cardiac arrest (OHCA) patients, with special attention to the protein C anticoagulant pathway. BACKGROUND: Successfully resuscitated cardiac arrest is followed by a systemic inflammatory response and by activation of coagulation, both of which may contribute to organ failure and neurological dysfunction. METHODS: Coagulation parameters were measured in all patients admitted after successfully resuscitated OHCA. RESULTS: At admission, 67 patients had a systemic inflammatory response with increased interleukin-6 and coagulation activity (thrombin-antithrombin complex), reduced anticoagulation (antithrombin, protein C, and protein S), activated fibrinolysis (plasmin-antiplasmin complex), and, in some cases, inhibited fibrinolysis (increased plasminogen activator inhibitor-1 with a peak on day 1). These abnormalities were more severe in patients who died within two days (50 of 67, 75%) and were most severe in patients dying from early refractory shock. Protein C and S levels were low compared to healthy volunteers and discriminated OHCA survivors from nonsurvivors. Furthermore, a subgroup of patients had a transient increase in plasma-activated protein C at admission followed by undetectable levels. This, along with an increase in soluble thrombomodulin over time, suggests secondary endothelial injury and dysfunction of the protein C anticoagulant pathway similar to that observed in severe sepsis. CONCLUSIONS: Major coagulation abnormalities were found after successful resuscitation of cardiac arrest. These abnormalities are consistent with secondary down-regulation of the thrombomodulin-endothelial protein C receptor pathway.
OBJECTIVES: We investigated coagulation abnormalities in out-of-hospital cardiac arrest (OHCA) patients, with special attention to the protein C anticoagulant pathway. BACKGROUND: Successfully resuscitated cardiac arrest is followed by a systemic inflammatory response and by activation of coagulation, both of which may contribute to organ failure and neurological dysfunction. METHODS: Coagulation parameters were measured in all patients admitted after successfully resuscitated OHCA. RESULTS: At admission, 67 patients had a systemic inflammatory response with increased interleukin-6 and coagulation activity (thrombin-antithrombin complex), reduced anticoagulation (antithrombin, protein C, and protein S), activated fibrinolysis (plasmin-antiplasmin complex), and, in some cases, inhibited fibrinolysis (increased plasminogen activator inhibitor-1 with a peak on day 1). These abnormalities were more severe in patients who died within two days (50 of 67, 75%) and were most severe in patients dying from early refractory shock. Protein C and S levels were low compared to healthy volunteers and discriminated OHCA survivors from nonsurvivors. Furthermore, a subgroup of patients had a transient increase in plasma-activated protein C at admission followed by undetectable levels. This, along with an increase in soluble thrombomodulin over time, suggests secondary endothelial injury and dysfunction of the protein C anticoagulant pathway similar to that observed in severe sepsis. CONCLUSIONS: Major coagulation abnormalities were found after successful resuscitation of cardiac arrest. These abnormalities are consistent with secondary down-regulation of the thrombomodulin-endothelial protein C receptor pathway.
Authors: Nathan J White; Benjamin Sieu-Hon Leong; Jessica Brueckner; Erika J Martin; Donald F Brophy; Mary A Peberdy; Joseph Ornato; Kevin R Ward Journal: Resuscitation Date: 2011-04-08 Impact factor: 5.262
Authors: Mitchell Jay Cohen; Mariah Call; Mary Nelson; Carolyn S Calfee; Charles T Esmon; Karim Brohi; Jean Francois Pittet Journal: Ann Surg Date: 2012-02 Impact factor: 12.969
Authors: Alexandro Gianforcaro; Michael Kurz; Francis X Guyette; Clifton W Callaway; Jon C Rittenberger; Jonathan Elmer Journal: Resuscitation Date: 2017-10-12 Impact factor: 5.262
Authors: Jonathon Wertz; Ankur A Doshi; Francis X Guyette; Clifton W Callaway; Jon C Rittenberger Journal: Resuscitation Date: 2013-03-22 Impact factor: 5.262
Authors: Karim Brohi; Mitchell J Cohen; Michael T Ganter; Michael A Matthay; Robert C Mackersie; Jean-François Pittet Journal: Ann Surg Date: 2007-05 Impact factor: 12.969