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Creatine kinase and creatine kinase-MB release after nontraumatic cardiac arrest
1Department of Emergency Medicine, Vienna General Hospital-University of Vienna, Medical School, Vienna, Austria.
Insights
Serum creatine kinase (CK) and CK-MB levels frequently rise after cardiac arrest, influenced by myocardial infarction, defibrillation energy, and chest trauma. This elevation impacts acute myocardial infarction diagnosis.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Cardiac arrest survivors often exhibit elevated serum creatine kinase (CK) and its MB fraction (CK-MB).
- Understanding factors influencing CK and CK-MB release is crucial for accurate diagnosis post-cardiac arrest.
Purpose of the Study:
- To describe the temporal profile of serum CK and CK-MB in survivors of cardiac arrest.
- To identify factors associated with CK and CK-MB release in this patient population.
Main Methods:
- Retrospective analysis of cardiopulmonary resuscitation data and prospective laboratory blood investigations.
- 107 adult patients surviving witnessed cardiac arrest for 24 hours in Vienna were studied.
- Serum CK and CK-MB levels were measured on admission and at 6, 12, and 24 hours post-admission.
Main Results:
- Over 75% of patients showed elevated CK and CK-MB within 24 hours.
- CK and CK-MB release correlated with electrocardiographic evidence of acute myocardial infarction (AMI), defibrillation energy, and chest trauma duration.
- The CK-MB/CK ratio was elevated in 32% of patients; only 49% of those with AMI evidence had an elevated ratio.
Conclusions:
- Elevated serum CK and CK-MB are common in non-traumatic cardiac arrest survivors.
- These elevations are linked to both ischemic myocardial injury and physical chest trauma.
- Interpretation of CK and CK-MB levels for AMI diagnosis requires consideration of these confounding factors.
Abstract:
The aim of the study was to describe the course of serum creatine kinase (CK) and its MB fraction (CK-MB) in patients surviving cardiac arrest, and to identify factors influencing CK and CK-MB release. The study was set in the community of Vienna, Austria. Data concerning cardiopulmonary resuscitation, collected within a period of 33 months, were evaluated retrospectively and compared with laboratory blood investigations collected prospectively (on admission and after 6, 12, and 24 hours) in 107 adult patients surviving a witnessed cardiac arrest for 24 hours. CK and CK-MB were elevated in >75% of the patients within 24 hours. Release of CK and CK-MB was mainly associated with electrocardiographic evidence of acute myocardial infarction (AMI) cumulative energy administered during defibrillation, and duration of chest trauma by compression. The CK-MB/CK ratio was elevated in 32% of the patients. Of patients with electrocardiographic evidence of AMI, only 49% had an elevated CK-MB/CK ratio. In conclusion, the elevation in serum CK and CK-MB fraction in patients after nontraumatic cardiac arrest is a frequent finding, and is associated with ischemic myocardial injury, as well as physical trauma to the chest. This should be considered when interpreting the course of CK and CK-MB fraction for the diagnosis of AMI.