ISSN:
1432-1238
Keywords:
Cardiopulmonary arrest
;
Cardiopulmonary resuscitation
;
Ischemia
;
Neutrophil elastase
;
Prognosis
;
Urinastatin
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Objective To determine the changes in neutrophil elastase levels in patients with cardiac arrest occurring outside the hospital and to evaluate the effects of urinastatin on these changes and on the clinical outoomes of the patients. Design Prospective study.Setting: The Emergency Department and a general ICU in the tertiary care city hospital. Patients Of the 40 patients who had an out-of-hospital cardiac arrest, 38 of the cases were randomized into 2 groups, with w cases being excluded because of contradiction to protocol. The control and urinastatin groups consisted of 20 and 18 patients, respectively. Interventions Control patients were treated by standard cardiopulmonary resuscitation (CPR) procedures. Patients in the urinastatin group were administered a 100000 U dose of urinastatin immediately after arrival at the Emergency Department and three 100000 U doses at 8h intervals, within the first 24h after resuscitation. Measurements and main results At the time of arrival at the emergency room (before administration of urinastatin), and at 30 min, 60 min, and 24h after, the plasma levels of neutrophil elastase and blood gas levels were determined. Concerning the baseline characteristics of patients, causes of cardiac arrest, time duration of pre-hospital care and treatments given during CPR, there was no difference detected between the control and urinastatin groups. In addition, the pH and PaO2 values showed no differences. Neutrophil elastase values had already increased by the time of arrival and continued to do so until 60 min; at 24h after admission, markedly higher values were obtained. These values were significantly higher in the non-resuscitated cases than in the resuscitated ones. Administration of urinastatin significantly suppressed this increase at 24h, but did not improve the clinical outcomes, including resuscitation rate and survival rate. Conclusions Accompanying cardiopulmonary arrest and resuscitation, neutrophils are activated and elastase is released. Elevated elastase level is associated with poorer prognosis. Urinastatin can suppress the release of elastase, when utilized at the dose described in this study, did not improve the clinical outcomes of patients who had suffered an out-of-hospital cardiac arrest.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01711540
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