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

Voß, Fabian; Karbenn, Matthias; Hoffmann, Till; Schweitzer, Julian; Jung, Christian; Bernhard, Michaël; Kienbaum, Peter; Kelm, Malte; Westenfeld, Ralf

doi:10.1111/micc.12729

Cited by 4 publications

(1 citation statement)

References 30 publications

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“…Other initiatives that might help to position levosimendan in sepsis include the use of methodologies such as side-stream dark-field imaging of the microcirculation [ 36 ] to investigate the relation between systemic haemodynamic effects of levosimendan and changes in the microcirculation that might be relevant to organ perfusion in sepsis. We know of no such studies currently in progress or development.…”

Section: Septic Shockmentioning

confidence: 99%

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

Girardis

Béttex

Bojan

et al. 2022

J Anesth Analg Crit Care

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The inodilator levosimendan, in clinical use for over two decades, has been the subject of extensive clinical and experimental evaluation in various clinical settings beyond its principal indication in the management of acutely decompensated chronic heart failure. Critical care and emergency medicine applications for levosimendan have included postoperative settings, septic shock, and cardiogenic shock. As the experience in these areas continues to expand, an international task force of experts from 15 countries (Austria, Belgium, China, Croatia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Spain, Sweden, Switzerland, and the USA) reviewed and appraised the latest additions to the database of levosimendan use in critical care, considering all the clinical studies, meta-analyses, and guidelines published from September 2019 to November 2021. Overall, the authors of this opinion paper give levosimendan a “should be considered” recommendation in critical care and emergency medicine settings, with different levels of evidence in postoperative settings, septic shock, weaning from mechanical ventilation, weaning from veno-arterial extracorporeal membrane oxygenation, cardiogenic shock, and Takotsubo syndrome, in all cases when an inodilator is needed to restore acute severely reduced left or right ventricular ejection fraction and overall haemodynamic balance, and also in the presence of renal dysfunction/failure.

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Section: Septic Shockmentioning

confidence: 99%

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

Girardis

Béttex

Bojan

et al. 2022

J Anesth Analg Crit Care

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Cardiac arrest and microcirculatory dysfunction: a narrative review

Kravitz,

Lee,

Shapiro

2024

Current Opinion in Critical Care

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Purpose of review This review provides an overview of the role of microcirculation in cardiac arrest and postcardiac arrest syndrome through handheld intravital microscopy and biomarkers. It highlights the importance of microcirculatory dysfunction in postcardiac arrest outcomes and explores potential therapeutic targets. Recent findings Sublingual microcirculation is impaired in the early stage of postarrest and is potentially associated with increased mortality. Recent work suggests that the proportion of perfused small vessels is predictive of mortality. Microcirculatory impairment is consistently found to be independent of macrohemodynamic parameters. Biomarkers of endothelial cell injury and endothelial glycocalyx degradation are elevated in postarrest settings and may predict mortality and clinical outcomes, warranting further studies. Recent studies of exploratory therapies targeting microcirculation have shown some promise in animal models but still require significant research. Summary Although research continues to suggest the important role that microcirculation may play in postcardiac arrest syndrome and cardiac arrest outcomes, the existing studies are still limited to draw any definitive conclusions. Further research is needed to better understand microcirculatory changes and their significance to improve cardiac arrest care and outcomes.

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Temporary decrease in microvascular tissue saturation after transcatheter aortic valve implantation

Stern,

Baasen,

Wischmann

et al. 2024

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BACKGROUND: Data on the effect of transcatheter aortic valve implantation (TAVI) on peripheral microcirculation are limited. OBJECTIVE: The aim of this study is to evaluate peripheral microvascular tissue saturation (StO2) before and after TAVI in relation to central and peripheral hemodynamics, cardiac and renal function. METHODS: In this single-center prospective study, patients with severe aortic stenosis (sAS) scheduled for TAVI or cardiac catheterization (control) were assessed before and up to five days after the procedure. Cardiac function including cardiac output (CO) was assessed by echocardiography. Brachial (bBP) and central blood pressure (cBP), ankle brachial index (ABI), and parameters of arterial stiffness, including augmentation pressure (AP) and augmentation index adjusted for heart rate (AIx@HR75) were measured to assess hemodynamic changes. StO2 was measured in all extremities using a near-infrared spectroscopy (NIRS) camera. Renal function was measured by creatinine levels. RESULTS: 26 patients underwent TAVI and 11 patients served as control. Cardiac output was significantly increased, whereas hemodynamic parameters and peripheral StO2 were significantly decreased after TAVI. At follow-up, StO2 returned to baseline values. Changes in StO2 were negatively related to creatinine levels. CONCLUSION: Transcatheter aortic valve implantation causes a temporary decrease in microvascular tissue saturation that is associated with renal function.

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

Cited by 4 publications

References 30 publications

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

Cardiac arrest and microcirculatory dysfunction: a narrative review

Temporary decrease in microvascular tissue saturation after transcatheter aortic valve implantation

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