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Microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study

BACKGROUND: Current research highlights the role of microcirculatory disorders in post-cardiac arrest patients. Affected microcirculation shows not only dissociation from systemic hemodynamics but also strong connection to outcome of these patients. However, only few studies evaluated microcirculati...

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Autores principales: Krupičková, Petra, Mlček, Mikuláš, Huptych, Michal, Mormanová, Zuzana, Bouček, Tomáš, Belza, Tomáš, Lacko, Stanislav, Černý, Miloš, Neužil, Petr, Kittnar, Otomar, Linhart, Aleš, Bělohlávek, Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898356/
https://www.ncbi.nlm.nih.gov/pubmed/27277706
http://dx.doi.org/10.1186/s12967-016-0934-5
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author Krupičková, Petra
Mlček, Mikuláš
Huptych, Michal
Mormanová, Zuzana
Bouček, Tomáš
Belza, Tomáš
Lacko, Stanislav
Černý, Miloš
Neužil, Petr
Kittnar, Otomar
Linhart, Aleš
Bělohlávek, Jan
author_facet Krupičková, Petra
Mlček, Mikuláš
Huptych, Michal
Mormanová, Zuzana
Bouček, Tomáš
Belza, Tomáš
Lacko, Stanislav
Černý, Miloš
Neužil, Petr
Kittnar, Otomar
Linhart, Aleš
Bělohlávek, Jan
author_sort Krupičková, Petra
collection PubMed
description BACKGROUND: Current research highlights the role of microcirculatory disorders in post-cardiac arrest patients. Affected microcirculation shows not only dissociation from systemic hemodynamics but also strong connection to outcome of these patients. However, only few studies evaluated microcirculation directly during cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). The aim of our experimental study in a porcine model was to describe sublingual microcirculatory changes during CA and CPR using recent videomicroscopic technology and provide a comparison to parameters of global hemodynamics. METHODS: Cardiac arrest was induced in 18 female pigs (50 ± 3 kg). After 3 min without treatment, 5 min of mechanical CPR followed. Continuous hemodynamic monitoring including systemic blood pressure and carotid blood flow was performed and blood lactate was measured at the end of baseline and CPR. Sublingual microcirculation was assessed by the Sidestream Dark Field (SDF) technology during baseline, CA and CPR. Following microcirculatory parameters were assessed off-line separately for capillaries (≤20 µm) and other vessels: total and perfused vessel density (TVD, PVD), proportion of perfused vessels (PPV), microvascular flow index (MFI) and heterogeneity index (HI). RESULTS: In comparison to baseline the CA small vessel microcirculation was only partially preserved: TVD 15.64 (13.59–18.48) significantly decreased to 12.51 (10.57–13.98) mm/mm(2), PVD 15.57 (13.56–17.80) to 5.53 (4.17–6.60) mm/mm(2), PPV 99.64 (98.05–100.00) to 38.97 (27.60–46.29) %, MFI 3.00 (3.00–3.08) to 1.29 (1.08–1.58) and HI increased from 0.08 (0.00–0.23) to 1.5 (0.71–2.00), p = 0.0003 for TVD and <0.0001 for others, respectively. Microcirculation during ongoing CPR in small vessels reached 59–85 % of the baseline values: TVD 13.33 (12.11–15.11) mm/mm(2), PVD 9.34 (7.34–11.52) mm/mm(2), PPV 72.34 (54.31–87.87) %, MFI 2.04 (1.58–2.42), HI 0.65 (0.41–1.07). The correlation between microcirculation and global hemodynamic parameters as well as to lactate was only weak to moderate (i.e. Spearman’s ρ 0.02–0.51) and after adjustment for multiple correlations it was non-significant. CONCLUSIONS: Sublingual microcirculatory parameters did not correlate with global hemodynamic parameters during simulated porcine model of CA and CPR. SDF imaging provides additional information about tissue perfusion in the course of CPR. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12967-016-0934-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-48983562016-06-09 Microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study Krupičková, Petra Mlček, Mikuláš Huptych, Michal Mormanová, Zuzana Bouček, Tomáš Belza, Tomáš Lacko, Stanislav Černý, Miloš Neužil, Petr Kittnar, Otomar Linhart, Aleš Bělohlávek, Jan J Transl Med Research BACKGROUND: Current research highlights the role of microcirculatory disorders in post-cardiac arrest patients. Affected microcirculation shows not only dissociation from systemic hemodynamics but also strong connection to outcome of these patients. However, only few studies evaluated microcirculation directly during cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). The aim of our experimental study in a porcine model was to describe sublingual microcirculatory changes during CA and CPR using recent videomicroscopic technology and provide a comparison to parameters of global hemodynamics. METHODS: Cardiac arrest was induced in 18 female pigs (50 ± 3 kg). After 3 min without treatment, 5 min of mechanical CPR followed. Continuous hemodynamic monitoring including systemic blood pressure and carotid blood flow was performed and blood lactate was measured at the end of baseline and CPR. Sublingual microcirculation was assessed by the Sidestream Dark Field (SDF) technology during baseline, CA and CPR. Following microcirculatory parameters were assessed off-line separately for capillaries (≤20 µm) and other vessels: total and perfused vessel density (TVD, PVD), proportion of perfused vessels (PPV), microvascular flow index (MFI) and heterogeneity index (HI). RESULTS: In comparison to baseline the CA small vessel microcirculation was only partially preserved: TVD 15.64 (13.59–18.48) significantly decreased to 12.51 (10.57–13.98) mm/mm(2), PVD 15.57 (13.56–17.80) to 5.53 (4.17–6.60) mm/mm(2), PPV 99.64 (98.05–100.00) to 38.97 (27.60–46.29) %, MFI 3.00 (3.00–3.08) to 1.29 (1.08–1.58) and HI increased from 0.08 (0.00–0.23) to 1.5 (0.71–2.00), p = 0.0003 for TVD and <0.0001 for others, respectively. Microcirculation during ongoing CPR in small vessels reached 59–85 % of the baseline values: TVD 13.33 (12.11–15.11) mm/mm(2), PVD 9.34 (7.34–11.52) mm/mm(2), PPV 72.34 (54.31–87.87) %, MFI 2.04 (1.58–2.42), HI 0.65 (0.41–1.07). The correlation between microcirculation and global hemodynamic parameters as well as to lactate was only weak to moderate (i.e. Spearman’s ρ 0.02–0.51) and after adjustment for multiple correlations it was non-significant. CONCLUSIONS: Sublingual microcirculatory parameters did not correlate with global hemodynamic parameters during simulated porcine model of CA and CPR. SDF imaging provides additional information about tissue perfusion in the course of CPR. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12967-016-0934-5) contains supplementary material, which is available to authorized users. BioMed Central 2016-06-08 /pmc/articles/PMC4898356/ /pubmed/27277706 http://dx.doi.org/10.1186/s12967-016-0934-5 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Krupičková, Petra
Mlček, Mikuláš
Huptych, Michal
Mormanová, Zuzana
Bouček, Tomáš
Belza, Tomáš
Lacko, Stanislav
Černý, Miloš
Neužil, Petr
Kittnar, Otomar
Linhart, Aleš
Bělohlávek, Jan
Microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study
title Microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study
title_full Microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study
title_fullStr Microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study
title_full_unstemmed Microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study
title_short Microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study
title_sort microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898356/
https://www.ncbi.nlm.nih.gov/pubmed/27277706
http://dx.doi.org/10.1186/s12967-016-0934-5
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