BACKGROUND: The neurological prognostication is crucial for the management of refractory out-of-hospital cardiac arrest (OHCA) patients. Despite treatment advances, ischemia-reperfusion brain injury remains a critical factor affecting neurological outcomes. This study evaluated the utility of intestinal fatty acid-binding protein (I-FABP) and its relationship with non-occlusive mesenteric ischemia (NOMI) for neurological prognostication, comparing patients with refractory cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (ECPR) compared to those treated with conventional CPR. METHODS: This is a single-center prospective pilot study. We compared I-FABP levels in OHCA patients recruited from June 2022 to October 2023. Blood samples for I-FABP examination were collected at admission, 24, and 48 h and analyzed against 30-day neurological outcomes and NOMI occurrence. ROC analysis determined I-FABP cut-off values for predicting poor neurological outcomes (Cerebral Performance Category (CPC) 3-5) in ECPR and CPR groups. RESULTS: Among the 68 patients admitted for OHCA, 22 received ECPR and 46 conventional CPR. I-FABP cut-off values for predicting poor neurological outcomes were: at admission > 0.95 ng/mL for ECPR vs. 1.64 ng/mL for CPR (AUC 0.55 vs. 0.38); at 24 h > 0.04 ng/mL vs. 0.4 ng/mL (AUC 0.7 vs. 0.51); at 48 h > 0.18 ng/mL vs. 0.53 ng/mL (AUC 0.77 vs. 0.41). However, compared to NSE AUCs, I-FABP showed significantly worse outcomes prediction in all time points.I-FABP was unreliable in predicting neurological outcomes and also showed no consistent elevation in NOMI patients. CONCLUSION: Compared to neuron-specific enolase, I-FABP does not appear to be a predictor of outcome in patients with refractory cardiac arrest. Clinical manifestations of NOMI are not consistently associated with elevated I-FABP levels.

1st Faculty of Medicine Charles University Prague Czech Republic

2nd Department of Cardiovascular Medicine General University Hospital Prague 1st Faculty of Medicine Charles University Prague Prague Czech Republic

3rd Department of Internal Medicine 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czech Republic

Critical Care Research Group Brisbane Queensland Australia

Department of Anesthesiology and Intensive Care Medicine 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czech Republic

Institute of Heart Diseases Wroclaw Medical University Wroclaw Poland

Institute of Medical Biochemistry and Laboratory Diagnostics 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

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