Plasma endothelin-1 level at the onset of ischemic ventricular fibrillation predicts resuscitation outcome

Background: Endogenous vasopressors, including endothelin-1 (ET-1), have been shown to be elevated in patients following resuscitation from out-of-hospital Cardiac arrest and are likely a physiologic response to global ischaemia. The importance of ET-1 in the setting of arrest and resuscitation has not been established. Prior work has demonstrated that ET-1 increases significantly after coronary Occlusion. The purpose of this study was to assess changes in ET-1 following induction of ischaemia and VF. Methods: VF was induced in 30 anesthetized and instrumented swine by balloon occlusion of the LAD. Blood was collected from the right atrium at baseline and at 5 min intervals following LAD occlusion until VF occurred. After 7 min of VF, resuscitation was attempted in accordance with guidelines. ET-1 and matrix metalloproteinase-9 (MMP-9), a measure of infarct size, were measured using ELISA. Results: ET-1 and MMP-9 levels increased significantly from baseline within 20 min of occlusion of the LAD. Animals that Could not be resuscitated had a higher ET-1 (p = 0.031) at VF onset but similar ischaemia time (time to VF) and MMP-9, reflecting infarct size. An ET-1 level >4 pg/ml had a likelihood ratio of 4 for predicting resuscitation failure. Conclusions: Elevated levels of ET-1 during acute ischaemia predict resuscitation failure independent of the time to VF. This finding may be clue to the known effect of ET-1 on coronary vascular resistance or ventricular compliance, resulting in early ischemic contracture. (C) 2009 Elsevier Ireland Ltd. All rights reserved.