Microvascular hemodynamics in human hypothermic circulatory arrest and selective antegrade cerebral perfusion

Abstract

In a controlled surgical setting, circulatory arrest in humans induces a complete sublingual small microvessel shutdown within 1 min. However, flow in larger microvessels persists. Selective antegrade cerebral perfusion was able to restore microvascular flow to precirculatory arrest levels within a similar timeframe.

Sublingual and muscular microcirculatory alterations after cardiac arrest: A pilot study

“…19 Moreover, in human hypothermic cardiac arrest induced for aortic arch surgery, selective antegrade cerebral perfusion rapidly restored microvascular flow to pre-arrest levels. 27 Nevertheless, the microcirculation was evaluated for only a limited observation time and deep hypothermia used during aortic arch surgery may have different effects on systemic and regional haemodynamics than mild hypothermia, making any extrapolation to the cardiac arrest setting difficult.…”

Haemodialysis Impairs the Human Microcirculation Independent from Macrohemodynamic Parameters

“…In previous studies by us and others, intraobserver variability ranges between 2.5 and 9.3% for PVD and between 0 and 4.5% for PPV. The interobserver variability is slightly higher: between 3.0 and 10.1% and between 0 and 10%, respectively [17,22]. …”

“…MFI is the sum of these flow scores divided by the number of quadrants in which the vessel type is visible. The intraobserver agreement κ score of MFI is 0.78 and 0.95 and interobserver agreement between 0.77 and 1 [18,20,22]. For each time point and each patient, the scores for MFI were averaged.…”

The response of the microcirculation to cardiac surgery

“…However, there are no studies of the microcirculatory alterations that occur during intraoperative cardioplegia-induced arrest [25]. Nevertheless, Elbers et al [70] demonstrated that circulatory arrest in humans induces an immediate and complete shutdown of the small sublingual microvessels, whereas the flow in the larger microvessels persists.…”