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

• Infliximab (Drug): The TNF-α antagonist (infliximab) used by the experimenter was manufactured by Hisun Biopharmaceuticals Ltd. under the trade name "anbaite".The dosage was administered at 5 mg/kg, dissolved in 250 mL of 0.9% sodium chloride injection, and delivered via intravenous infusion over 2 hours.
• Sodium chloride injection USP, 0.9% (placebo) (Drug): Patients in the control group received 250 mL of 0.9% sodium chloride injection as a placebo, administered via intravenous infusion over 2 hours.

Primary outcomes

• 30-day survival rate [30 days after randomization.]: All-cause survival rate of patients on day 30 after randomization.

Secondary outcomes

• Rate of good neurological function assessed by Modified Rankin scale neurologic function scores [30 days, 3 months, and 6 months after randomization]: Modified Rankin scale neurologic function scores at 30 days, 3 months, and 6 months after randomization. Neurological function was assessed using the mRS scales, with mRS 0-3 scores indicating a good neurological prognosis, and mRS 4-6 scores indicating a poor neurological prognosis.
• Rate of good neurological function assessed by cerebral performance category scores [30 days, 3 months, and 6 months after randomization]: Cerebral performance category(CPC) scores at 30 days, 3 months, and 6 months after randomization. Neurological function was assessed using the CPC, with CPC 1-2 indicating a good neurological prognosis, and CPC 3-5 scores indicating a poor neurological prognosis.
• prolong follow-up survival rate [3 months and 6 months after randomization]: survival rate
• systematic scoring [24 hours (h), 48 hours, 72 hours and 1 week after randomization]: The Sequential Organ Failure Assessment (SOFA) Score-ranging from 0 (minimum) to 24 (maximum), with higher scores indicating more severe organ dysfunction and worse clinical outcomes-was measured at 24 hours, 48 hours, 72 hours, and 1 week after randomization.
• Serum concentrations of systemic inflammatory response markers [24 hours (h), 48 hours, 72 hours and 1 week after randomization]: CRP, WBC, IL-1 β, IL-6, TNF - α, etc at 24h, 48h, 72h and 1 week after randomization
• Serum concentrations of myocardial injury markers [24 hours (h), 48 hours, 72 hours and 1 week after randomization]: TNI,BNP,MYO,CKMB,etc at 24h, 48h, 72h and 1 week after randomization
• Serum concentrations of neuronal specific enolase [24 hours (h), 48 hours, 72 hours and 1 week after randomization]: NSE at 24h, 48h, 72h and 1 week after randomization

Sex: All, ages: 18 Years to any

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)

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