Kozakov Kostiantyn, Provaznik Zdenek, Foltan Maik, Li Jing, Petermichl Walter, Stadlbauer Christian, Wiesner Sigrid, Turtsevich Dzmitry, Keyser Andreas, Rupprecht Leopold, Schmid Christof, Schopka Simon
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg 93053, Germany.
Department of Anaesthesiology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg 93053, Germany.
Resusc Plus. 2025 May 28;24:100995. doi: 10.1016/j.resplu.2025.100995. eCollection 2025 Jul.
Extracorporeal life support (ECLS) is increasingly employed for severe respiratory or cardiac failure, alongside a rising adoption of extracorporeal cardiopulmonary resuscitation (eCPR). Despite increased adoption, limited evidence underscores possible cytokines' pivotal role in the inflammatory response during ECLS.
The study involved 546 eCPR patients using veno-arterial extracorporeal membrane oxygenation from 2013 to 2023. Categorized into in-hospital eCPR (IHCA, 358 patients) and out-of-hospital eCPR (OHCA, 188 patients) groups, a retrospective analysis explored associations among interleukin 6 (IL6), interleukin 8 (IL8), tumor necrosis factor-alpha (TNF-alpha), soluble interleukin-2 receptor (sIL2R), and pivotal post-resuscitation syndrome (PRS) components. Cytokine dynamics were assessed before and after ECLS initiation.
CPR-to-ECLS time was significantly longer in the OHCA group ( = 0.009), correlating with elevated IL6 and IL8 levels. The IHCA group showed more favorable neurological outcomes ( < 0.001), but presented with a higher incidence of multiple organ failure ( < 0.001) compared to the OHCA group. The IHCA group exhibited pronounced IL6 and IL8 levels prior to ECLS initiation significantly decreasing post-ECLS initiation ( = 0.01 and = 0.008), whereas OHCA patients showed peak levels of IL6 and IL8 during the course of ECLS ( < 0.001).
IL6 and IL8 are associated with key elements of the post-resuscitation syndrome (neurological outcome, organ dysfunction and hemodynamic status) in patients undergoing eCPR for refractory cardiac arrest, possibly providing a predictive ability of organ dysfunction in OHCA patients without a preceding pro-inflammatory burden.
体外生命支持（ECLS）越来越多地用于治疗严重呼吸或心力衰竭，同时体外心肺复苏（eCPR）的应用也在增加。尽管应用越来越广泛，但有限的证据强调了细胞因子在ECLS期间炎症反应中可能起的关键作用。
该研究纳入了2013年至2023年期间使用静脉-动脉体外膜肺氧合的546例eCPR患者。分为院内eCPR（IHCA，358例患者）和院外eCPR（OHCA，188例患者）两组，进行回顾性分析，探讨白细胞介素6（IL6）、白细胞介素8（IL8）、肿瘤坏死因子-α（TNF-α）、可溶性白细胞介素-2受体（sIL2R）与复苏后综合征（PRS）关键组成部分之间的关联。在ECLS开始前后评估细胞因子动态变化。
OHCA组的心肺复苏至ECLS时间明显更长（P = 0.009），与IL6和IL8水平升高相关。与OHCA组相比，IHCA组的神经学预后更好（P < 0.001），但多器官功能衰竭的发生率更高（P < 0.001）。IHCA组在ECLS开始前IL6和IL8水平显著升高，ECLS开始后显著下降（P = 0.01和P = 0.008），而OHCA患者在ECLS过程中IL6和IL8水平达到峰值（P < 0.001）。
IL6和IL8与难治性心脏骤停接受eCPR患者的复苏后综合征关键要素（神经学预后、器官功能障碍和血流动力学状态）相关，可能为无前炎症负担的OHCA患者的器官功能障碍提供预测能力。
