title: A comparison of etanercept vs. infliximab for the treatment of post-arrest myocardial dysfunction in a swine model of ventricular fibrillation.
abstract: OBJECTIVE
  To compare the effects of two TNF-α antagonists, etanercept and infliximab, on post-cardiac arrest hemodynamics and global left ventricular function (LV) in a swine model following ventricular fibrillation (VF).
  
  
  METHODS
  Domestic swine (n=30) were placed under general anesthesia and instrumented before VF was induced electrically. After 7 min of VF, standard ACLS resuscitation was performed. Animals achieving return of spontaneous circulation (ROSC) were randomized to immediately receive infliximab (5 mg/kg, n=10) or etanercept (0.3 mg/kg [4 mg/m(2)], n=10) or vehicle (250 mL normal saline [NS], n=10) and LV function and hemodynamics were monitored for 3 h.
  
  
  RESULTS
  Following ROSC, mean arterial pressure (MAP), stroke work (SW), and LV dP/dt fell from pre-arrest values in all groups. However, at the 30 min nadir, infliximab-treated animals had higher MAP than either the NS group (difference 14.4 mm Hg, 95% confidence interval [CI] 4.2-24.7) or the etanercept group (19.2 mm Hg, 95% CI 9.0-29.5), higher SW than the NS group (10.3 gm-m, 95% CI 5.1-15.5) or the etanercept group (8.9 gm-m, 95% CI 4.0-14.4) and greater LV dP/dt than the NS group (282.9 mm Hg/s, 95% CI 169.6-386.1 higher with infliximab) or the etanercep group (228.9 mm Hg/s, 95% CI 115.6-342.2 higher with infliximab).
  
  
  CONCLUSIONS
  Only infliximab demonstrated a beneficial effect on post cardiac arrest hemodynamics and LV function in this swine model. Etanercept was no better in this regard than saline.
authors: Department of Surgery, Division of Emergency Medicine, The University of Utah, Salt Lake, UT 84132, USA. scott.youngquist@utah.edu
authors: Scott T
authors: ST
authors: Youngquist
authors: James T
authors: JT
authors: Niemann
authors: Atman P
authors: AP
authors: Shah
authors: Joseph L
authors: JL
authors: Thomas
authors: John P
authors: JP
authors: Rosborough
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D000911:Antibodies, Monoclonal / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D004195:Disease Models, Animal; D000068800:Etanercept; D006324:Heart Arrest, Induced; D007074:Immunoglobulin G / Q000494:pharmacology*; D000069285:Infliximab; D011897:Random Allocation; D018124:Receptors, Tumor Necrosis Factor; D013552:Swine; D014409:Tumor Necrosis Factor-alpha; D014693:Ventricular Fibrillation / Q000188:drug therapy*; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept