Resuscitation 82 (2011) 690–695 Contents lists available at ScienceDirect Resuscitation journal homepage: www.elsevier.com/locate/resuscitation Clinical paper Sublingual and muscular microcirculatory alterations after cardiac arrest: A pilot study  Katia Donadello a , Raphael Favory a , Diamantino Salgado-Ribeiro a , Jean-Louis Vincent a , Leonardo Gottin b , Sabino Scolletta a , Jacques Creteur a , Daniel De Backer a , Fabio Silvio Taccone a,∗ a Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium b Department of Intensive Care, Policilinico Universitario G.B.Rossi, Univerità degli Studi di Verona, Verone, Italy article info Article history: Received 6 October 2010 Received in revised form 25 January 2011 Accepted 11 February 2011 Keywords: Cardiac arrest Therapeutic hypothermia Microcirculation SDF NIRS abstract Aims of the study: Post-cardiac arrest resuscitated patients often develop a “sepsis-like” syndrome, which may be associated with organ dysfunction. Impaired microcirculatory blood flow is thought to play a key role in sepsis-induced organ failure; however, few data are available on the microcirculation after cardiac arrest. We investigated microvascular density and reactivity in the early phase following cardiac arrest. Methods: We prospectively evaluated the sublingual microcirculation in 10 patients admitted to the inten- sive care unit (ICU) after cardiac arrest using a Sidestream Dark Field device. Thenar oxygen saturation (StO 2 ) was also measured using a tissue spectrometer and a vaso-occlusive test was performed by rapid inflation of a pneumatic cuff around the arm to evaluate the StO 2 reperfusion rate, reflecting microvas- cular reactivity. In all patients, measurements were performed within the first 12 h after admission (T1) and 24–48 h thereafter (T2). Results: There was a significant increase in functional capillary density (FCD, 7.2 ± 1.9–10.0 ± 1.4 N/mm, p = 0.001), in the proportion of small perfused vessels (PSPV, 76 ± 13–92 ± 3%, p = 0.004) and in the mean microvascular flow index (MFI, 2.1 ± 0.5–2.8 ± 0.2, p = 0.003) at T2 compared to T1. FCD and PSPV were significantly correlated to body temperature, but not to cardiac output or mean arterial pressure. The StO 2 reperfusion rate did not change over the study period and showed considerable inter-individual variability. Conclusions: The early post-resuscitation phase is characterised by significant abnormalities in microvas- cular density and flow, which return to normal within 48 h after cardiac arrest. These changes may be influenced by body temperature. Microvascular reactivity is impaired after cardiac arrest. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Cardiac arrest is a major health and economic problem. 1 Although resuscitation practices have improved, the mortality rate of survivors of cardiopulmonary resuscitation (CPR) remains high. 1–3 Various factors, such as duration of arrest, bystander resus- citation, quality of CPR, initial rhythm, and early defibrillation, can influence the prognosis of patients after cardiac arrest. 4 More- over, after return of spontaneous circulation (ROSC) and hospital admission, haemodynamic derangements are common and may have a negative impact on the degree of post-anoxic neurologi-  “A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.02.018”. ∗ Corresponding author at: Department of Intensive Care, Erasme Hospital, 808, route de Lennik, 1070 Brussels, Belgium. Tel.: +32 2 555 33 80; fax: +32 2 555 46 98. E-mail address: ftaccone@ulb.ac.be (F.S. Taccone). cal injury. 5–7 Specifically, high levels of circulating cytokines and plasma endotoxin, leucocyte and platelet dysregulation, and acti- vation of coagulation may contribute to the development of a systemic inflammatory response syndrome (SIRS), similar to that observed in sepsis, 8 and of cardiovascular abnormalities, eventually leading to the multiple organ dysfunction syndrome (MODS). 9 During the past few years, the International Liaison Committee on Resuscitation (ILCOR) has focused its research on the patho- physiology of these systemic alterations, commonly referred to as the “post-cardiac arrest syndrome”, and on the best therapeutic approach. 10,11 Restoration of an adequate blood pressure and car- diac output alone does not necessarily reduce the occurrence of MODS, suggesting that, as in sepsis, 12 inappropriate microvascular perfusion may contribute to organ dysfunction after cardiac arrest. The microcirculation is essential to deliver oxygen and nutri- ents to the tissues. 13 Recent investigations in patients with sepsis have shown a decrease in capillary density and an increased het- erogeneity of blood flow with perfused capillaries in close vicinity 0300-9572/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2011.02.018