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Coagulopathy After Successful Cardiopulmonary Resuscitation Following Cardiac Arrest

Implication of the Protein C Anticoagulant Pathway

Christophe Adrie, MD^_*,_*, Mehran Monchi, MD, Ivan Laurent, MD, Suzan Um, BS, S. Betty Yan, PhD, Marie Thuong, MD^_*, Alain Cariou, MD, Julien Charpentier, MD and Jean François Dhainaut, MD

^_* Intensive Care Unit, Delafontaine Hospital, Saint Denis, France
Intensive Care Unit, Jacques Cartier Hospital, Massy, France
Lilly Research Laboratories, Eli Lilly Company, Indianapolis, Indiana
Medical Intensive Care Medicine, Cochin Hospital, University of Paris V, Paris, France

View larger version (34K): [in a new window]   Figure 1 Changes in coagulation over the first two intensive care unit days in 67 patients successfully resuscitated after out-of-hospital cardiac arrest, 17 survivors (S) (open boxes) and 50 nonsurvivors (NS) (black boxes). Patients receiving oral anticoagulation were excluded from the protein C and S graphs. Of the 67 patients studied at admission, 8 died within one day and 17 within two days. Repeated-measures analysis of variance was used to compare the time-course of coagulation markers between S and NS. Medians are shown as lines, 25th to 75th percentiles as boxes, and 5th to 95th ranges as error bars. PAP = plasmin-antiplasmin complex; sTM = soluble thrombomodulin; TAT = thrombin-antithrombin complex.

View larger version (17K): [in a new window]   Figure 2 Activated protein C levels in plasma of 16 patients successfully resuscitated after out-of-hospital cardiac arrest. We observed an early transient increase in activated protein C levels at admission. Of the 16 patients, 4 died within one day and 5 within two days. Protein C levels were undetectable (1 ng/ml) in 2 of 16 patients (13%) at admission, 9 of 12 patients on day 1 (75%), and 8 of 9 patients (89%) on day 2. This explains the overlapping dot symbols. None of the healthy volunteers exhibited detectable levels of activated protein C.