Microvascular perfusion in cardiac arrest: a review of microcirculatory imaging studies

Abstract

Cardiac arrest represents a leading cause of mortality and morbidity in developed countries. Extracorporeal cardiopulmonary resuscitation (ECPR) increases the chances for a beneficial outcome in victims of refractory cardiac arrest. However, ECPR and post-cardiac arrest care are affected by high mortality rates due to multi-organ failure syndrome, which is closely related to microcirculatory disorders. Therefore, microcirculation represents a key target for therapeutic interventions in post-cardiac arrest patients. However, the evaluation of tissue microcirculatory perfusion is still demanding to perform. Novel videomicroscopic technologies (Orthogonal polarization spectral, Sidestream dark field and Incident dark field imaging) might offer a promising way to perform bedside microcirculatory assessment and therapy monitoring. This review aims to summarise the recent body of knowledge on videomicroscopic imaging in a cardiac arrest setting and to discuss the impact of extracorporeal reperfusion and other therapeutic modalities on microcirculation.

Physiology-Guided Resuscitation: Monitoring and Augmenting Perfusion during Cardiopulmonary Arrest

“…While the results are both promising and interesting, much remains to be learned. Whether interventions aimed to restore microcirculation during and after cardiac arrest improve outcomes requires further exploration [ 26 ].…”

Personalized physiology-guided resuscitation in highly monitored patients with cardiac arrest—the PERSEUS resuscitation protocol

“…During CPR, arterial blood pressure may correlate only poorly with microcirculatory flow and normalization or elevating blood pressure with vasopressors may result in unpredictable effects on microcirculatory and capillary perfusion, despite reaching initial resuscitation endpoints, such as DAP and/or ETCO 2 [17,18]. As prolonged resuscitation leads to accrual of ischemic injury and results in ischemic contracture of the heart that inevitably becomes unresponsive to defibrillation and resuscitation efforts [9], a CPR method that provides higher tissue perfusion may lead to better outcomes by delaying ischemic cardiac contracture and decreasing neurological injury.…”

Brain perfusion evaluated by regional tissue oxygenation as a possible quality indicator of ongoing cardiopulmonary resuscitation. An experimental porcine cardiac arrest study

“…3,4 Its relationship to patient outcome has been documented by current meta-analyses. 5,6 Moreover, it allows rapid application, simple use and non-invasive bed-side continuous monitoring. NIRS-derived indexes reflect mixed arterial and venous oxygen saturation levels in tissues under the light-emitting probe.…”

“…Microcirculatory changes during cardiac arrest, though, have been linked to prognosis. 6 Therefore, a prospective porcine study was designed to correlate cerebral and peripheral regional oxygen saturations (rSO 2 ) to microcirculatory changes during cardiac arrest and cardiopulmonary resuscitation (CPR). Later, we correlated cerebral and peripheral rSO 2 to systemic hemodynamic parameters (systemic arterial pressure and carotid blood flow) provided by detailed hemodynamic monitoring.…”