Sublingual microcirculation is impaired in post-cardiac arrest patients
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Published on: December 10, 2020
Yasser G Omar1, Michael Massey, Lars W Andersen
1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Aim:
We hypothesized that microcirculatory dysfunction, similar to that seen in sepsis, occurs in post-cardiac arrest patients and that better microcirculatory flow will be associated with improved outcome. We also assessed the association between microcirculatory dysfunction and inflammatory markers in the post-cardiac arrest state.
Methods:
We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield microscopy. Microcirculatory flow was assessed using the microcirculation flow index (MFI) at 6 and 24h in the cardiac arrest patients, and within 6h of emergency department admission in the sepsis and control patients.
Results:
We evaluated 30 post-cardiac arrest patients, 16 severe sepsis/septic shock patients, and 9 healthy control patients. Sublingual microcirculatory blood flow was significantly impaired in post-cardiac arrest patients at 6h (MFI 2.6 [IQR: 2-2.9]) and 24h (2.7 [IQR: 2.3-2.9]) compared to controls (3.0 [IQR: 2.9-3.0]; p<0.01 and 0.02, respectively). After adjustment for initial APACHE II score, post-cardiac arrest patients had significantly lower MFI at 6-h compared to sepsis patients (p<0.03). In the post-cardiac arrest group, patients with good neurologic outcome had better microcirculatory blood flow as compared to patients with poor neurologic outcome (2.9 [IQR: 2.4-3.0] vs. 2.6 [IQR: 1.9-2.8]; p<0.03). There was a trend toward higher median MFI at 24h in survivors vs. non-survivors (2.8 [IQR: 2.4-3.0] vs. 2.6 [IQR: 2.1-2.8] respectively; p<0.09). We found a negative correlation between MFI-6 and vascular endothelial growth factor (VEGF) (r=-0.49, p=0.038). However, after Bonferroni adjustment for multiple comparisons, this correlation was statistically non-significant.
Conclusion:
Microcirculatory dysfunction occurs early in post-cardiac arrest patients. Better microcirculatory function at 24h may be associated with good neurologic outcome.
Insights
Post-cardiac arrest patients exhibit early microcirculatory dysfunction, similar to sepsis. Improved microcirculatory blood flow correlates with better neurologic outcomes, highlighting its importance in patient recovery.
Area of Science:
- Critical Care Medicine
- Cardiovascular Research
- Microcirculation Studies
Background:
- Microcirculatory dysfunction is a hallmark of sepsis, contributing to organ damage.
- The role of microcirculatory impairment in post-cardiac arrest (CA) patients remains less understood.
- Early identification of microcirculatory changes may guide therapeutic interventions.
Purpose of the Study:
- To investigate microcirculatory dysfunction in post-cardiac arrest patients compared to sepsis patients and healthy controls.
- To determine the association between microcirculatory function and patient outcomes, including neurologic recovery.
- To explore the relationship between microcirculatory dysfunction and inflammatory markers in the post-CA state.
Main Methods:
- Prospective evaluation of sublingual microcirculation using Sidestream Darkfield microscopy.
- Inclusion of post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy controls.
- Assessment of microcirculation flow index (MFI) at 6 and 24 hours post-arrest and within 6 hours for sepsis/control groups.
Main Results:
- Post-cardiac arrest patients showed significantly impaired microcirculatory blood flow (MFI) at 6h and 24h compared to controls.
- MFI was significantly lower in post-cardiac arrest patients at 6h compared to sepsis patients, even after adjusting for APACHE II score.
- Good neurologic outcome in post-CA patients was associated with better microcirculatory blood flow at 24h (p<0.03).
Conclusions:
- Microcirculatory dysfunction is an early finding in patients following cardiac arrest.
- Enhanced microcirculatory function at 24 hours post-arrest may predict favorable neurologic outcomes.
- Further research is warranted to explore the link between microcirculation and inflammatory markers.
