Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Resuscitation. 2013 Dec;84(12):1717-22. doi: 10.1016/j.resuscitation.2013.07.012. Epub 2013 Jul 18.
We hypothesized that microcirculatory dysfunction, similar to that seen in sepsis, occurs in post-cardiac arrest patients and that better microcirculatory flow will be associated with improved outcome. We also assessed the association between microcirculatory dysfunction and inflammatory markers in the post-cardiac arrest state.
We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield microscopy. Microcirculatory flow was assessed using the microcirculation flow index (MFI) at 6 and 24h in the cardiac arrest patients, and within 6h of emergency department admission in the sepsis and control patients.
We evaluated 30 post-cardiac arrest patients, 16 severe sepsis/septic shock patients, and 9 healthy control patients. Sublingual microcirculatory blood flow was significantly impaired in post-cardiac arrest patients at 6h (MFI 2.6 [IQR: 2-2.9]) and 24h (2.7 [IQR: 2.3-2.9]) compared to controls (3.0 [IQR: 2.9-3.0]; p<0.01 and 0.02, respectively). After adjustment for initial APACHE II score, post-cardiac arrest patients had significantly lower MFI at 6-h compared to sepsis patients (p<0.03). In the post-cardiac arrest group, patients with good neurologic outcome had better microcirculatory blood flow as compared to patients with poor neurologic outcome (2.9 [IQR: 2.4-3.0] vs. 2.6 [IQR: 1.9-2.8]; p<0.03). There was a trend toward higher median MFI at 24h in survivors vs. non-survivors (2.8 [IQR: 2.4-3.0] vs. 2.6 [IQR: 2.1-2.8] respectively; p<0.09). We found a negative correlation between MFI-6 and vascular endothelial growth factor (VEGF) (r=-0.49, p=0.038). However, after Bonferroni adjustment for multiple comparisons, this correlation was statistically non-significant.
Microcirculatory dysfunction occurs early in post-cardiac arrest patients. Better microcirculatory function at 24h may be associated with good neurologic outcome.
我们假设，心脏骤停后患者存在类似于脓毒症的微循环功能障碍，且更好的微循环血流与改善的预后相关。我们还评估了心脏骤停后状态下微循环功能障碍与炎症标志物之间的相关性。
我们前瞻性地使用边流暗场显微镜评估了心脏骤停后患者、严重脓毒症/脓毒性休克患者和健康对照患者的舌下微循环。在心脏骤停患者中，分别于 6 和 24 小时评估微循环血流，在脓毒症和对照组患者中于急诊就诊后 6 小时内评估微循环血流。
我们评估了 30 例心脏骤停后患者、16 例严重脓毒症/脓毒性休克患者和 9 例健康对照患者。与对照组相比，心脏骤停后患者在 6 小时（MFI 2.6 [IQR：2-2.9]）和 24 小时（2.7 [IQR：2.3-2.9]）时舌下微循环血流明显受损（均 p<0.01 和 0.02）。在校正初始急性生理与慢性健康状况评分 II （APACHE II）评分后，与脓毒症患者相比，心脏骤停后患者在 6 小时时的 MFI 明显更低（p<0.03）。在心脏骤停后组中，与神经功能不良患者相比，神经功能良好患者的微循环血流更好（2.9 [IQR：2.4-3.0] 与 2.6 [IQR：1.9-2.8]；p<0.03）。与非幸存者相比，幸存者在 24 小时时的中位数 MFI 有升高的趋势（2.8 [IQR：2.4-3.0] 与 2.6 [IQR：2.1-2.8]；p<0.09）。我们发现 MFI-6 与血管内皮生长因子（VEGF）之间存在负相关（r=-0.49，p=0.038）。但是，在进行多次比较的 Bonferroni 校正后，该相关性无统计学意义。
心脏骤停后患者早期即存在微循环功能障碍。24 小时时更好的微循环功能可能与良好的神经功能预后相关。
