VCAM1 and systemic inflammatory response syndrome: In post-cardiac arrest syndrome, elevated P- and E-selectin, soluble vascular cell adhesion molecule-1, and soluble intercellular molecule-1 are observed after CPR.[6,15] Elevated adhesion molecules indicate neutrophil activation and subsequent endothelial injury.[6,15] The hyporesponsiveness of circulating leukocytes, like neutrophil paralysis in patients with systemic inflammatory response syndrome, appears to protect against the overwhelming pro-inflammatory response.[6,15]