title: High Level of Endotoxemia Following Out-of-Hospital Cardiac Arrest Is Associated With Severity and Duration of Postcardiac Arrest Shock.
abstract: OBJECTIVE
  To investigate the contribution of endotoxemia to the severity of postcardiac arrest shock.
  
  
  METHODS
  A prospective monocentric study.
  
  
  METHODS
  A tertiary hospital in Paris, France.
  
  
  METHODS
  Patients admitted in our ICU after a successfully resuscitated out-of-hospital cardiac arrest.
  
  
  METHODS
  None.
  
  
  RESULTS
  Endotoxin measurement was performed in the 12 hours following return of spontaneous circulation using the endotoxin activity assay. Endotoxin level was classified as low (< 0.4 endotoxin activity), intermediate (0.4 to < 0.6 endotoxin activity), or high (≥ 0.6 endotoxin activity) according to manufacture guidelines. Severity of shock was assessed by the vasopressor-free days and by the mean daily dose of vasopressor to insure a mean arterial pressure of 65-75 mm Hg. Among 92 patients included in the study, 60 presented a postcardiac arrest shock. Endotoxemia level was higher in patients with postcardiac arrest shock. Among these patients, by multivariate linear regression, high endotoxin class (adjusted estimate -2.0; 95% CI, -3.90 to -0.11), public place of cardiac arrest (adjusted estimate, 1.47; 95% CI, 0.007 to 2.93), and time to return of spontaneous circulation (adjusted estimate -0.08; 95% CI, -0.13 to -0.03) were independently associated with the number of vasopressor-free days. Furthermore, high endotoxin class (adjusted estimate, 97.95; 95% CI, 20.5 to 175.4) and a nonshockable rhythm (adjusted estimate, 59.9; 95% CI, 6.2 to 113.7) were the sole factors independently associated with the mean daily dose of vasopressors.
  
  
  CONCLUSIONS
  In patients successfully resuscitated from cardiac arrest with a postcardiac arrest shock, high level of endotoxemia is independently associated with duration of postcardiac arrest shock and the amount of vasopressive drugs. Whether treatment targeting endotoxemia could be beneficial in the management of postcardiac arrest shock needs to be studied in further randomized controlled studies.
authors.affiliation: 1Intensive Care Unit, Centre Hospitalier Versailles, Le Chesnay, France. 2Medical Intensive Care Unit, Cochin University Hospital, AP-HP, Paris, France. 3Paris Descartes University, Sorbonne Paris Cité, Medical School, Paris, France. 4INSERM, U970, Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France. 5Emergency Department, Groupe Hospitalier Broca Cochin Hotel-Dieu, AP-HP, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Grimaldi
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sauneuf
authors.forename: Elise
authors.initials: E
authors.lastname: Guivarch
authors.forename: Sylvie
authors.initials: S
authors.lastname: Ricome
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zuber
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
mesh_terms: D000368:Aged; D015415:Biomarkers; D016887:Cardiopulmonary Resuscitation; D019446:Endotoxemia / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood / Q000150:complications* / Q000628:therapy; D010297:Paris; D011446:Prospective Studies; D012720:Severity of Illness Index; D012769:Shock / Q000097:blood / Q000209:etiology*; D062606:Tertiary Care Centers; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D015415:Biomarkers; D014662:Vasoconstrictor Agents