Changes in Inflammatory Cytokines during Rewarming Period of Therapeutic Hypothermia for Post-Cardiac Arrest Patients

Lee, Hui Jai; Suh, Gil Joon; Kwon, Woon Yong; Kim, Kyung Su; Jung, Yoon Sun; You, Kyoung Min; Kye, Youchan

J Korean Soc Emerg Med > Volume 27(2); 2016 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2016;27(2): 173-181.

Changes in Inflammatory Cytokines during Rewarming Period of Therapeutic Hypothermia for Post-Cardiac Arrest Patients

Hui Jai Lee¹, Gil Joon Suh², Woon Yong Kwon², Kyung Su Kim², Yoon Sun Jung³, Kyoung Min You², Youchan Kye⁴

¹Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
²Seoul National University Hospital, Seoul, Republic of Korea
³National Medical Center, Seoul, Republic of Korea
⁴VHS Medical Center, Seoul, Republic of Korea

Correspondence

Gil Joon Suh ,Tel: 02) 2072-2927, Fax: 02) 3672-8871, Email: suhgil@snu.ac.kr,

Received: January 30, 2016; Revised: February 2, 2016 Accepted: March 7, 2016. Published online: April 30, 2016.

ABSTRACT

Purpose:
Therapeutic hypothermia is an important treatment strategy for control of the overwhelming inflammatory reactions of cardiac arrest patients. Rapid rewarming is related to poor outcome, however the kinds of inflammatory processes that occur during the rewarming period are not well understood. Our aim in the current study was to evaluate the changes in inflammatory cytokine levels during cardiac arrest patients’ rewarming period.
Method:
This study was conducted in an emergency intensive care unit of a tertiary referral hospital. Blood samples were collected on admission (0 h) and 24, 26, 28, and 32 h after return of spontaneous circulation. Eight inflammatory cytokines (E-selectin, soluble ICAM, interleukin-10, interleukin-1ra, interleukin-6, interleukin-8, monocyte chemotactic protein-1, and tumor necrosis factor-α) were measured.
Results:
Twenty-eight patients were enrolled and completed a protocol of 24 h hypothermia and 8h rewarming. Eight patients were of the good cerebral performance category (CPC) and 20 of the bad. The IL-1Ra level in the good CPC group was statistically changed at 26 (p=0.039) and 28 (p=0.003) but not at 32 h (p=0.632) when compared with the 24 h level. The IL-10 levels of the bad CPC group were decreased at 26 (p=0.017) and 28h (p=0.013) but not at 32 h (p=0.074) when compared with 24 h. None of the other cytokines showed meaningful differences during the rewarming period.
Conclusion:
Change in inflammatory-cytokine-level change during the rewarming period is not significant.

Key words: Hypothermia induced, Heart arrest, Cytokines, Prognosis