• Anna S P Meyer, Per I Johansson, Jesper Kjaergaard, Martin Frydland, MeyerMartin A SMASSection for Transfusion Medicine, Blood Bank, Rigshospitalet, 2034, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. Electronic address: martin.as.meyer@gmail.com., Hanne Hee Henriksen, Jakob H Thomsen, Sebastian C Wiberg, Christian Hassager, and Sisse R Ostrowski.
• Section for Transfusion Medicine, Blood Bank, Rigshospitalet, 2034, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Dept. of Cardiology, Rigshospitalet, 2143, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. Electronic address: anna.sina.pettersson.meyer.02@regionh.dk.
• Am. Heart J. 2020 Jan 1; 219: 9-20.

ObjectiveAn increasingly recognized prognostic factor for out-of-hospital-cardiac-arrest (OHCA) patients is the ischemia-reperfusion injury after restored blood circulation. Endothelial injury is common in patients resuscitated from cardiac arrest and is associated with poor outcome. This study was designed to investigate if iloprost infusion, a prostacyclin analogue, reduces endothelial damage in OHCA patients.Methods50 patients were randomized in a placebo controlled double-blinded trial and allocated 1:2 to 48-hours iloprost infusion, (1 ng/kg/min) or placebo (saline infusion). Endothelial biomarkers (soluble thrombomodulin (sTM), sE-selectin, syndecan-1, soluble vascular endothelial growth factor (sVEGF), vascular endothelial cadherine (VEcad), nucleosomes) and sympathoadrenal activation (epinephrine/norepinephrine) from baseline to 48 and 96-hours were evaluated.ResultsIloprost infusion did not influence endothelial biomarkers by the 48-hour endpoint. A rebound effect was observed with higher biomarker plasma values in the iloprost group (sTM p=0.02; Syndecan p=0.004; nucleosomes p<0.001; VEcad p<0.03) after 96-hours. There was a significant difference in 180-day mortality in favor of placebo. There was no difference regarding total adverse events between groups (p=0.73). Two patients were withdrawn in the iloprost group due to hypotension.ConclusionsThe administration of low-dose iloprost (1ng/kg/min) to OHCA patients did not significantly influence endothelial biomarkers as measured by the 48- hour endpoint. A rebound effect was however observed in the 96-hour statistical model, with increasing endothelial biomarker levels after cessation of the iloprost-infusion.Copyright © 2019 Elsevier Inc. All rights reserved.

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