Decreased human leukocyte antigen-D-related expression on CD14^(+)monocytes in patients with out-of-hospital cardiac arrest provided target temperature management therapy:a prospective observational study

Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with out-of-hospital cardiac arrest(OHCA)after return of spontaneous circulation(ROSC)by observing the changes in circulating CD14^(+)monocytes and the expression of human leukocyte antigen D–related(HLA-DR)and programmed cell death ligand 1(PD-L1)in CD14^(+)monocytes.Methods:Adult patients admitted to the emergency department of Beijing Chao-Yang Hospital after OHCA between January 2017 and March 2018 were included in this study.Thirty control subjects,10 patients with OHCA,and 37 patients with OHCA who received 72 hours of TTM therapy were enrolled.Peripheral blood samples of patients in the OHCA and TTM groups were collected on Days 1 and 3(D1 and D3)after ROSC and evaluated for HLA-DR and PD-L1 expression on CD14^(+)monocytes using flow cytometry.Results:Compared with control subjects,the percentage of circulating CD14^(+)monocytes,HLA-DR+/CD14^(+)monocyte ratios,and mean fluorescence intensity were significantly decreased in patients with OHCA.After ROSC,HLA-DR expression in CD14^(+)monocytes in the TTM group was lower than that in patients with OHCA.However,there were no significant differences in the percentage of PD-L1+/CD14^(+)monocytes or the mean fluorescence intensity between patients with OHCA and healthy volunteers.Conclusion:After ROSC,circulating CD14^(+)monocytes and HLA-DR+/CD14^(+)monocyte ratios decreased significantly in patients with OHCA.Human leukocyte antigen D–related expression in CD14^(+)monocytes was lower in patients treated with TTM.

Outcome of bystander cardiopulmonary resuscitation after out-of-hospital cardiac arrest in Beijing

Aim:We aimed to investigate the association between bystander cardiopulmonary resuscitation(CPR)and survival of patients with out-of-hospital cardiac arrests(OHCA)in Beiing.Methods:This observational study analyzed adult patients with OHCA treated by the Beiing emergency medical service(EMS)from January 2013 to December 2017.Data were collected in a Utstein style with a 1-year follow-up and a primary outcome 01 survival to hospital discharge.Secondary outcomes were return of spontaneous circulation(ROSC),survival to admission,favorable neurological outcome at hospital discharge,and survival and favorable neurological outcomes of up to 1 year.Results:A total of 5016 patients with OHCA from Beiing's urban area were recorded by EMS,wherein 765 patients(15.25%)underwent bystander CPR.The data were propensity score-matched forage,sex,location,witness,aetiology,initial rhythm,and call to EMS arrival to compare the difference between the occurrence and nonoccurrence of bystander CPR.The survival upon the discharge of patients who experienced bystander CPR was superior to that of patients who did not receive bystander CPR(3.7%vs 1.2%,respectively;P<0.001).Moreover,patients with OHCA resuscitated with bystander CPR achieved better outcomes of ROSC,survival to admission,favorable neurological outcome at hospital discharge,survival and favorable neurological outcome after 1 year compared with those who were not resuscitated with bystander CPR.Conclusion:Survival and neu rological outcome of patients who underwent bystander CPR was better than those who underwent nonbystander CPR in Beiing.However,the rate of bystander CPR was low.