title: Effect of Pulsatility on Microcirculation in Patients Treated with Extracorporeal Cardiopulmonary Resuscitation: A Pilot Study.
abstract: The effect of pulsatile blood flow on microcirculation during extracorporeal cardiopulmonary resuscitation (ECPR) is not elucidated; therefore, we designed an observational study comparing sublingual microcirculation in patients with refractory cardiac arrest (CA) with spontaneously pulsatile or low/nonpulsatile blood flow after treatment with ECPR. Microcirculation was assessed with Sidestream Dark Field technology in 12 patients with CA who were treated with ECPR and 12 healthy control subjects. Microcirculatory images were analyzed offline in a blinded fashion, and consensual parameters were determined for the vessels ≤20 μm. The patients' data, including actual hemodynamic parameters, were documented. Pulsatile blood flow was defined by a pulse pressure (PP) ≥ 15 mm Hg. Compared with the healthy volunteers, the patients who were treated with ECPR exhibited a significantly lower proportion of perfused capillaries (PPC); other microcirculatory parameters did not differ. The groups of patients with pulsatile (n = 7) versus low/nonpulsatile (n = 5) blood flow did not differ in regards to the collected data and hemodynamic variables (except for the PP and ejection fraction of the left ventricle) as well as microcirculatory parameters. In conclusion, microcirculation appeared to be effectively supported by ECPR in our group of patients with CA with the exception of the PPC. We found only nonsignificant contribution of spontaneous pulsatility to extracorporeal membrane oxygenation-generated microcirculatory blood flow.
authors.affiliation: From the *First Faculty of Medicine, Charles University in Prague, Katerinska, Prague, Czech Republic; †Department of Neonatology with NICU, University Hospital in Motol, V Uvalu, Prague, Czech Republic; ‡Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University in Prague, Zikova, Praha, Czech Republic; §Department of Neonatology, Krajska nemocnice Liberec, a. s., Husova, Liberec, Czech Republic; and ¶2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice, Prague, Czech Republic.
authors.forename: Petra
authors.initials: P
authors.lastname: Krupičková
authors.forename: Michal
authors.initials: M
authors.lastname: Huptych
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Mormanová
authors.forename: Tomáš
authors.initials: T
authors.lastname: Bouček
authors.forename: Tomáš
authors.initials: T
authors.lastname: Belza
authors.forename: Ondřej
authors.initials: O
authors.lastname: Šmíd
authors.forename: Aleš
authors.initials: A
authors.lastname: Král
authors.forename: Hana
authors.initials: H
authors.lastname: Skalická
authors.forename: Aleš
authors.initials: A
authors.lastname: Linhart
authors.forename: Jan
authors.initials: J
authors.lastname: Bělohlávek
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D010865:Pilot Projects; D011673:Pulsatile Flow / Q000502:physiology