Sublingual microcirculation predicts survival after out-of-hospital cardiac arrest

Despite successful resuscitation with return of spontaneous circulation (ROSC), the prediction of survival in patients suffering out-of-hospital cardiac arrest (OHCA) remains difficult. Several studies have shown alterations in sublingual microcirculation in the critical ill. We hypothesized that early alterations in sublingual microcirculation may predict short-term survival after OHCA.

We prospectively included all adults admitted to our university hospital between April and September 2019 with ROSC following OHCA. Sidestream dark-field microscopy to obtain sublingual microcirculation was performed at admission and after 6, 12 and 24 hours. Primary outcome was survival until discharge.

Twenty-five patients were included. Six hours after ROSC, the proportion of perfused small vessels (PPV_small ) was lower in non-survivors than in survivors (85 ± 7.9 vs. 75 ± 6.6%; p = .01). PPV_small did not correlate with serum lactate. Stratification for survival with cutoff values >78.4% for PPV_small 6 h post-admission and <5.15 mmol/l for initial serum lactate as suggested by ROC-Analyses results in a positive predictive value of 100% and a negative one of 67% for our study population.

Estimating short-term prognosis of OHCA patients with ROSC may be supported by measuring the PPV_small at the sublingual microcirculation 6 hours after admission.