TNF-α Antagonists Mitigate Systemic Inflammatory Response After Cardiac Arrest.

TNF-a Antagonists Attenuate the Systemic Inflammatory Response in Post-cardiac Arrest Syndrome: a Multi Centre, Double-blind, Randomised Controlled Clinical Study

The investigators assessed the effect of TNF-α antagonism within 6 hours of return of spontaneous circulation on 30-day mortality in patients who remained comatose after cardiopulmonary resuscitation (CPR) following cardiac arrest . In addition, the investigators explored the role of this treatment in modulating the systemic inflammatory response and its potential impact on 90- and 180-day morbidity and mortality and neurological outcomes.

Inclusion Criteria:

1. Patients aged ≥18 years;
2. Patients with suspected cardiogenic cardiac arrest;
3. Patients with comatose state after ROSC (Glasgow Coma Scale [GCS] score <9);
4. Patients with Return of spontaneous circulation (ROSC) sustained for >20 minutes;

Exclusion Criteria:

1. Cardiac arrest due to trauma;
2. Suspected or confirmed hemorrhagic or ischemic stroke;
3. Pregnancy;
4. Cardiac arrest without witnessed collapse;
5. Admission body temperature <30°C;
6. Persistent cardiogenic shock (defined as systolic blood pressure below 90mmHg during the screening period despite adequate fluid resuscitation, vasopressors, and positive inotropic drug support);
7. Time from ROSC to randomization exceeding 4 hours;
8. Left ventricular ejection fraction (LVEF) <35% after ROSC;
9. Known allergy to TNF - α antagonist components
10. Known tuberculosis or other active infection;
11. Diagnosed advanced malignant tumors with an estimated survival period of less than 6 months;
12. Pre-existing severe neurological dysfunction before cardiac arrest (e.g., Cerebral Performance Category [CPC] 3-4);
13. End stage renal disease relies on dialysis;
14. Severe chronic obstructive pulmonary disease (COPD) and other diseases require long-term home oxygen therapy;
15. Being in a state of severe immune suppression (such as long-term use of immunosuppressants after autoimmune diseases or organ transplantation, or patients with severe immunodeficiency diseases)；
16. History of liver cirrhosis;
17. History of chronic heart failure, heart function III-IV (NYHA)