CONCENTRATIONS OF PROLACTIN AND PROSTAGLANDINS DURING AND AFTER CARDIOPULMONARY-RESUSCITATION

Objectives: To assess differences in plasma prolactin and prostaglandi n concentrations in resuscitated and nonresuscitated patients during c ardiopulmonary resuscitation (CPR), and to compare changes of prostagl andin and prolactin concentrations with hemodynamic variables in the i mmediate postresuscitation phase. Design: Prospective, descriptive stu dy. Setting: Emergency medical service at a university hospital. Patie nts: Twenty-nine patients ranging in age from 39 to 87 yrs with out-of -hospital cardiac arrest. Interventions: Venous blood samples were tak en during CPR and at 5, 15, 30, and 60 mins after restoration of spont aneous circulation in order to measure plasma concentrations of prolac tin, prostaglandin F-2 alpha, 15-keto-13,14-dihydro-prostaglandin F-2 alpha, 6-keto-prostaglandin F-2 alpha, and thromboxane B-2 by immunoas say. Heart rate and blood pressure were measured at 5, 15, 30, and 60 mins after restoration of spontaneous circulation. Measurements and Ma in Results: In 15 patients, restoration of spontaneous circulation was achieved; in the remaining 14 patients, successful resuscitation was not possible. During CPR, the mean plasma prolactin, prostaglandin F-2 alpha, 15-keto-13,14-dihydro-prostaglandin F-2 alpha, 6-keto-prostagl andin F-2 alpha, and thromboxane B-2 concentrations were 95.9 +/- 13.6 mu g/L, 357 +/- 61 ng/L, 228 +/- 28 ng/L, 277 +/- 66 ng/L, and 375 +/ - 78 ng/L, respectively, in resuscitated patients, and 23.9 +/- 5.6 mu g/L (p = .0001), 192 +/- 22 ng/L (p = .005), 202 +/- 31 ng/L (p = .52 8), 221 +/- 40 ng/L (p = .713), and 344 +/- 77 ng/L (p = .780), respec tively, in nonresuscitated patients. At 60 mins after restoration of s pontaneous circulation, the mean plasma prolactin, prostaglandin F-2 a lpha, 15-keto-13,14-dihydro-prostaglandin F-2 alpha, 6-keto-prostaglan din F-1 alpha, and thromboxane B-2 concentrations were 50.1 +/- 9.5 mu g/L, 306 +/- 42 ng/L, 503 +/- 87 ng/L, 278 +/- 55 ng/L, and 355 +/- 3 0 ng/L, respectively. Mean values of systolic arterial blood pressure were 114 +/- 12 mm Hg at 30 mins and 123 +/- 18 mm Hg at 60 mins. No s ignificant correlations were found between hemodynamic values and plas ma concentrations of prolactin or prostaglandins. Conclusions: Prolact in and prostaglandin concentrations were increased during cardiac arre st and CPR. Successful initial resuscitation was associated with incre ased prolactin and prostaglandin F-2 alpha concentrations during CPR. Decreased concentrations in nonresuscitated patients may have been a r esult of exhaustion of the neuroendocrine and eicosanoid systems, or m ay be due to differences in bioavailability at the site of blood sampl ing based upon differences in hemodynamics.