title: Successful cardiopulmonary resuscitation after cardiac arrest as a "sepsis-like" syndrome.
abstract: BACKGROUND
  We investigated the immunoinflammatory profile of patients successfully resuscitated after cardiac arrest, representing a model of whole-body ischemia/reperfusion syndrome.
  
  
  RESULTS
  Plasma cytokine, endotoxin, and ex vivo cytokine production in whole-blood assays was assessed in 61, 35, and 11 patients, respectively. On admission, high levels of plasma interleukin (IL)-6, IL-8, IL-10, and soluble tumor necrosis factor (TNF) receptor type II could discriminate between survivors and nonsurvivors. Among nonsurvivors, the initial need for a vasopressor agent was associated with higher levels of IL-1 receptor antagonist, IL-10, and IL-6 on day 1. Plasma endotoxin was detected in 46% of the analyzed patients within the 2 first days. Endotoxin-induced TNF and IL-6 productions were dramatically impaired in these patients compared with healthy control subjects, whereas an unaltered production was observed with heat-killed Staphylococcus aureus. In contrast, IL-1 receptor antagonist productions were enhanced in these patients compared with healthy control subjects. The productions of T-cell-derived IL-10 and interferon-gamma were also impaired in these patients. Finally, using in vitro plasma exchange between healthy control subjects and patients, we demonstrated that the endotoxin-dependent hyporeactivity was an intrinsic property of patients' leukocytes and that an immunosuppressive activity was also present in their plasma.
  
  
  CONCLUSIONS
  Altogether, the high levels of circulating cytokines, the presence of endotoxin in plasma, and the dysregulated production of cytokines found in these patients recall the immunological profile found in patients with sepsis.
authors.affiliation: Medical ICU, Cochin Hospital, Paris, France. christophe.adrie@wanadoo.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Minou
authors.initials: M
authors.lastname: Adib-Conquy
authors.forename: Ivan
authors.initials: I
authors.lastname: Laurent
authors.forename: Mehran
authors.initials: M
authors.lastname: Monchi
authors.forename: Christophe
authors.initials: C
authors.lastname: Vinsonneau
authors.forename: Catherine
authors.initials: C
authors.lastname: Fitting
authors.forename: François
authors.initials: F
authors.lastname: Fraisse
authors.forename: A Tuan
authors.initials: AT
authors.lastname: Dinh-Xuan
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dhainaut
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Cavaillon
mesh_terms: D000368:Aged; D015703:Antigens, CD / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D016207:Cytokines / Q000097:blood; D004731:Endotoxins / Q000097:blood; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007962:Leukocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000276:immunology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D047889:Receptors, Tumor Necrosis Factor, Type II; D012016:Reference Values; D015427:Reperfusion Injury; D012795:Sialoglycoproteins / Q000097:blood; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D015703:Antigens, CD; D016207:Cytokines; D004731:Endotoxins; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6; D016209:Interleukin-8; D018124:Receptors, Tumor Necrosis Factor; D047889:Receptors, Tumor Necrosis Factor, Type II; D012795:Sialoglycoproteins; D016753:Interleukin-10