Perturbation of the endothelial glycocalyx in post cardiac arrest syndrome

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• 作者：Sebastian Grundmann^a ; ^{sebastian.grundmann@uniklinik-freiburg.de} ; Katrin Fink^a ; Lyubomira Rabadzhieva ; Natascha Bourgeois ; Tilmann Schwab ; Martin Moser ; Christoph Bode ; Hans-Joerg Busch
• 关键词：Post cardiac arrest syndrome ; Post resuscitation care ; Cardiac arrest ; Glycocalyx
• 刊名：Resuscitation
• 出版年：2012
• 期刊代码：236_03009572
• 类别：med
• 出版时间：June, 2012
• 卷：83
• 期：6
• 页码：715-720
• 文件大小：307 K

摘要

Background

The prognosis of immediate survivors of cardiac arrest remains poor, as the majority of these patients develops an inflammatory disorder known as the post-cardiac arrest syndrome (PCAS). Recently, the endothelial glycocalyx has been shown to be a key modulator of vascular permeability and inflammation, but its role in PCAS remains unknown.

Methods

Plasma levels of the glycocalyx components syndecan-1, heparan sulfate and hyaluronic acid were measured in 25 patients after immediate survival of cardiac arrest during different phases of PCAS. Twelve hemodynamically stable patients with acute coronary syndrome served as controls.

Results

Cardiac arrest resulted in a significant increase in syndecan-1, heparan sulfate and hyaluronic acid levels compared to controls, indicating a shedding of the endothelial glycocalyx as a pathophysiological component of the post cardiac arrest syndrome. The time course differed between the individual glycocalyx components, with a higher increase of syndecan-1 in the early phase of PCAS (2.8-fold increase vs. controls) and a later peak of heparan sulfate (1.7-fold increase) and hyaluronic acid (2-fold increase) in the intermediate phase. Only the plasma levels of syndecan-1 correlated positively with the duration of CPR and negatively with the glycocalyx-protective protease inhibitor antithrombin III. Plasma levels of both syndecan-1 and heparan sulfate were higher in eventual non-survivors than in survivors of cardiac arrest.

Conclusion

Our data for the first time demonstrates a perturbation of the endothelial glycocalyx in immediate survivors of cardiac arrest and indicate a potential important role of this endothelial surface layer in the development of post-cardiac arrest syndrome.