BACKGROUND

The neurological prognostication is crucial for the management of refractory out-of-hospital cardiac arrest (OHCA) patients. Despite treatment advances, ischemia-reperfusion brain injury remains a critical factor affecting neurological outcomes. This study evaluated the utility of intestinal fatty acid-binding protein (I-FABP) and its relationship with non-occlusive mesenteric ischemia (NOMI) for neurological prognostication, comparing patients with refractory cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (ECPR) compared to those treated with conventional CPR.

METHODS

This is a single-center prospective pilot study. We compared I-FABP levels in OHCA patients recruited from June 2022 to October 2023. Blood samples for I-FABP examination were collected at admission, 24, and 48 h and analyzed against 30-day neurological outcomes and NOMI occurrence. ROC analysis determined I-FABP cut-off values for predicting poor neurological outcomes (Cerebral Performance Category (CPC) 3-5) in ECPR and CPR groups.

RESULTS

Among the 68 patients admitted for OHCA, 22 received ECPR and 46 conventional CPR. I-FABP cut-off values for predicting poor neurological outcomes were: at admission > 0.95 ng/mL for ECPR vs. 1.64 ng/mL for CPR (AUC 0.55 vs. 0.38); at 24 h > 0.04 ng/mL vs. 0.4 ng/mL (AUC 0.7 vs. 0.51); at 48 h > 0.18 ng/mL vs. 0.53 ng/mL (AUC 0.77 vs. 0.41). However, compared to NSE AUCs, I-FABP showed significantly worse outcomes prediction in all time points.I-FABP was unreliable in predicting neurological outcomes and also showed no consistent elevation in NOMI patients.

CONCLUSION

Compared to neuron-specific enolase, I-FABP does not appear to be a predictor of outcome in patients with refractory cardiac arrest. Clinical manifestations of NOMI are not consistently associated with elevated I-FABP levels.