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Schroeder DC, Maul AC, Mahabir E, Koxholt I, Yan X, Padosch SA, Herff H, Bultmann-Mellin I, Sterner-Kock A, Annecke T, Hucho T, Böttiger BW, Guschlbauer M. Evaluation of small intestinal damage in a rat model of 6 Minutes cardiac arrest. BMC Anesthesiol 2018; 18:61. [PMID: 29866034 PMCID: PMC5993127 DOI: 10.1186/s12871-018-0530-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/25/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Contribution of the small intestine to systemic inflammation after cardiac arrest (CA) is poorly understood. The objective was to evaluate whether an in vivo rat model of 6 min CA is suitable to initiate intestinal ischaemia-reperfusion-injury and to evaluate histomorphological changes and inflammatory processes in the small intestinal mucosa resp. in sera. METHODS Adult male Wistar rats were subjected to CA followed by cardio-pulmonary resuscitation. Proximal jejunum and serum was collected at 6 h, 24 h, 72 h and 7 d post return of spontaneous circulation (ROSC) and from a control group. The small intestine was evaluated histomorphologically. Cytokine concentrations were measured in jejunum lysates and sera. RESULTS Histomorphological evaluation revealed a significant increase in mucosal damage in the jejunum at all timepoints compared to controls (p < 0.0001). In jejunal tissues, concentrations of IL-1α, IL-1β, IL-10, and TNF-α showed significant peaks at 24 h and were 1.5- to 5.7-fold higher than concentrations at 6 h and in the controls (p < 0.05). In serum, a significant higher amount of cytokine was detected only for IL-1β at 24 h post-ROSC compared to controls (15.78 vs. 9.76 pg/ml). CONCLUSION CA resulted in mild small intestinal tissue damage but not in systemic inflammation. A rat model of 6 min CA is not capable to comprehensively mimic a post cardiac arrest syndrome (PCAS). Whether there is a vital influence of the intestine on the PCAS still remains unclear.
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Affiliation(s)
- Daniel C. Schroeder
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
| | - Alexandra C. Maul
- Experimental Medicine, University Hospital of Cologne, Robert-Koch-Str.10, Cologne, Germany
| | - Esther Mahabir
- Comparative Medicine, Center for Molecular Medicine Cologne, University of Cologne, Robert-Koch-Str.21, Cologne, Germany
| | - Isabell Koxholt
- Comparative Medicine, Center for Molecular Medicine Cologne, University of Cologne, Robert-Koch-Str.21, Cologne, Germany
| | - Xiaowei Yan
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
| | - Stephan A. Padosch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
| | - Holger Herff
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
| | - Insa Bultmann-Mellin
- Experimental Medicine, University Hospital of Cologne, Robert-Koch-Str.10, Cologne, Germany
| | - Anja Sterner-Kock
- Experimental Medicine, University Hospital of Cologne, Robert-Koch-Str.10, Cologne, Germany
| | - Thorsten Annecke
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
| | - Tim Hucho
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
| | - Maria Guschlbauer
- Experimental Medicine, University Hospital of Cologne, Robert-Koch-Str.10, Cologne, Germany
- Decentral Animal Facility, University Hospital of Cologne, Robert-Koch-Str.10, Cologne, Germany
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Krupičková P, Mormanová Z, Bouček T, Belza T, Šmalcová J, Bělohlávek J. Microvascular perfusion in cardiac arrest: a review of microcirculatory imaging studies. Perfusion 2017; 33:8-15. [DOI: 10.1177/0267659117723455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Petra Krupičková
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- Department of Neonatology with NICU, Motol University Hospital, Prague, Czech Republic
| | - Zuzana Mormanová
- Department of Neonatology, Krajska Nemocnice Liberec, a. s., Liberec, Czech Republic
| | - Tomáš Bouček
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tomáš Belza
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jana Šmalcová
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Bělohlávek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Wu J, Li C, Yuan W. Effects of Shenfu injection on macrocirculation and microcirculation during cardiopulmonary resuscitation. JOURNAL OF ETHNOPHARMACOLOGY 2016; 180:97-103. [PMID: 26806577 DOI: 10.1016/j.jep.2016.01.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/21/2015] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Abstract
AIM OF THE STUDY To examine the effects of Shenfu injection (SFI) on macrocirculation and microcirculation during ventricular fibrillation (VF) and cardiopulmonary resuscitation (CPR). MATERIALS AND METHODS Sixteen female Landrace pigs were used in this study. After anesthesia, coronary perfusion pressure (CPP) was measured, and then the abdominal cavity was opened to observe the mesenteric microcirculation with the aid of sidestream dark field imaging. Following the guidelines, we determined microvascular flow index, perfused vessel density and proportion of perfused vessels both for large (diameter>20 μm) and small (diameter<20 μm) microvessels. SFI (1 ml/kg) or saline was given by vein injection at 1h before inducing VF. CPR was initiated after 4 min VF. RESULTS The shocks and duration of CPR were less in the SFI group compared with saline group. As the occurrence of VF, the CPP suddenly dropped to near zero, and cannot be measured in the both groups. However, there was greater CPP during CPR and at 1h after return of spontaneous circulation in the SFI group than saline group. Compared with saline, SFI significantly improved the microcirculation parameters of large and small microvessels during VF and CPR. CONCLUSIONS SFI can improve the microvascular blood flow and CPP during VF and CPR, and reduce the shocks and duration of CPR.
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Affiliation(s)
- Junyuan Wu
- Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No: BZ0370), Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020 China.
| | - Chunsheng Li
- Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No: BZ0370), Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020 China.
| | - Wei Yuan
- Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No: BZ0370), Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020 China.
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Omar YG, Massey M, Andersen LW, Giberson TA, Berg K, Cocchi MN, Shapiro NI, Donnino MW. Sublingual microcirculation is impaired in post-cardiac arrest patients. Resuscitation 2013; 84:1717-22. [PMID: 23871865 DOI: 10.1016/j.resuscitation.2013.07.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/04/2013] [Accepted: 07/08/2013] [Indexed: 12/29/2022]
Abstract
AIM 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. METHODS 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. RESULTS 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. CONCLUSION Microcirculatory dysfunction occurs early in post-cardiac arrest patients. Better microcirculatory function at 24h may be associated with good neurologic outcome.
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Affiliation(s)
- Yasser G Omar
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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The patient is in cardiac arrest! Letʼs be snappy: Prepare a bolus of sodium nitroprusside, while I compress the chest. Itʼs not a joke!*. Crit Care Med 2011; 39:1548-9. [DOI: 10.1097/ccm.0b013e318211fa6e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Donadello K, Favory R, Salgado-Ribeiro D, Vincent JL, Gottin L, Scolletta S, Creteur J, De Backer D, Taccone FS. Sublingual and muscular microcirculatory alterations after cardiac arrest: A pilot study. Resuscitation 2011; 82:690-5. [DOI: 10.1016/j.resuscitation.2011.02.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 01/25/2011] [Accepted: 02/11/2011] [Indexed: 01/19/2023]
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Microvascular flow during mechanical cardiopulmonary resuscitation. Resuscitation 2010; 81:5. [DOI: 10.1016/j.resuscitation.2009.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 09/19/2009] [Indexed: 11/19/2022]
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