No-reflow After Cardiac Arrest

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 1995 Feb 1

PMID 7775694

Citations 30

Authors

M Fischer

K A Hossmann

Affiliations

Soon will be listed here.

Abstract

Objective: Successful resuscitation of the brain requires unimpaired blood recirculation. The study addresses the question of the severity and reversibility of no-reflow after cardiac arrest.

Design: Adult normothermic cats were submitted to 5, 15 and 30 min cardiac arrest by ventricular fibrillation. The extent of no-reflow was assessed in each cardiac arrest group after 5 min closed chest cardiac massage in combination with 0.2 mg/kg epinephrine or after successful resuscitation followed by 30 min recirculation.

Measurements And Results: Reperfusion of the brain was visualized by labelling the circulating blood with FITC-Albumin. Areas of no-reflow, defined as absence of microvascular filling, were identified by fluorescence microscopy at 8 standard coronal levels of forebrain, and expressed as percent of total sectional area. During cardiac massage, no-reflow affected 21 +/- 5%, 42 +/- 38% and 70 +/- 27% of forebrain after 5, 15 and 30 min cardiac arrest, respectively. After 30 min spontaneous recirculation following successful resuscitation of the heart, no-reflow significantly declined to 7 +/- 11% after 5 min cardiac arrest (p < 0.05) but persisted in 30 +/- 11% and 65 +/- 21% of forebrain after 15 and 30 min cardiac arrest, respectively (n.s.).

Conclusion: Our observations demonstrate that resuscitation of the heart by closed chest massage causes severe (and after prolonged cardiac arrest irreversible) no-reflow of the brain. This suggests that no-reflow is an important cause of post-resuscitation brain pathology.

Citing Articles

Leukocyte filtration and leukocyte modulation therapy during extracorporeal cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest.

VanZalen J, Nakashima T, Phillips A, Hill J, Westover A, Lou L Sci Rep. 2024; 14(1):13081.

PMID: 38844477 PMC: 11156900. DOI: 10.1038/s41598-024-63522-w.

Effects of Prolonged Serum Calcium Suppression during Extracorporeal Cardiopulmonary Resuscitation in Pigs.

Pooth J, Liu Y, Petzold R, Scherer C, Benning L, Kreibich M Biomedicines. 2023; 11(10).

PMID: 37892986 PMC: 10604109. DOI: 10.3390/biomedicines11102612.

Coagulofibrinolytic effects of recombinant soluble thrombomodulin in prolonged porcine cardiac arrest.

Zhang B, McCracken B, Mahmood C, Leander D, Greer N, Cranford J Resusc Plus. 2023; 16:100477.

PMID: 37811363 PMC: 10550843. DOI: 10.1016/j.resplu.2023.100477.

Therapeutic Effect of Argatroban During Cardiopulmonary Resuscitation and Streptokinase During Extracorporeal Cardiopulmonary Resuscitation in a Porcine Model of Prolonged Cardiac Arrest.

VanZalen J, Harvey S, Hala P, Phillips A, Nakashima T, Gok E Crit Care Explor. 2023; 5(5):e0902.

PMID: 37181541 PMC: 10174369. DOI: 10.1097/CCE.0000000000000902.

Brain vulnerability and viability after ischaemia.

Daniele S, Trummer G, Hossmann K, Vrselja Z, Benk C, Gobeske K Nat Rev Neurosci. 2021; 22(9):553-572.

PMID: 34290397 DOI: 10.1038/s41583-021-00488-y.

References

Grogaard B, Schurer L, Gerdin B, Arfors K . Delayed hypoperfusion after incomplete forebrain ischemia in the rat. The role of polymorphonuclear leukocytes. J Cereb Blood Flow Metab. 1989; 9(4):500-5. DOI: 10.1038/jcbfm.1989.73. View

Fischer E, Ames 3rd A, LORENZO A . Cerebral blood flow immediately following brief circulatory stasis. Stroke. 1979; 10(4):423-7. DOI: 10.1161/01.str.10.4.423. View

Granger D . Role of xanthine oxidase and granulocytes in ischemia-reperfusion injury. Am J Physiol. 1988; 255(6 Pt 2):H1269-75. DOI: 10.1152/ajpheart.1988.255.6.H1269. View

Theilen H, Schrock H, Kuschinsky W . Capillary perfusion during incomplete forebrain ischemia and reperfusion in rat brain. Am J Physiol. 1993; 265(2 Pt 2):H642-8. DOI: 10.1152/ajpheart.1993.265.2.H642. View

Ginsberg M, Myers R . The topography of impaired microvascular perfusion in the primate brain following total circulatory arrest. Neurology. 1972; 22(10):998-1011. DOI: 10.1212/wnl.22.9.998. View

Rinderknecht H . Ultra-rapid fluorescent labelling of proteins. Nature. 1962; 193:167-8. DOI: 10.1038/193167b0. View

Lin S, Kormano M . Cerebral circulation after cardiac arrest. Microangiographic and protein tracer studies. Stroke. 1977; 8(2):182-8. DOI: 10.1161/01.str.8.2.182. View

Pretto E, Safar P, Saito R, Stezoski W, Kelsey S . Cardiopulmonary bypass after prolonged cardiac arrest in dogs. Ann Emerg Med. 1987; 16(6):611-9. DOI: 10.1016/s0196-0644(87)80056-2. View

Ames 3rd A, Wright R, Kowada M, THURSTON J, Majno G . Cerebral ischemia. II. The no-reflow phenomenon. Am J Pathol. 1968; 52(2):437-53. PMC: 2013326. View

10.

Rosenthal R, Williams R, Bogaert Y, Getson P, Fiskum G . Prevention of postischemic canine neurological injury through potentiation of brain energy metabolism by acetyl-L-carnitine. Stroke. 1992; 23(9):1312-7; discussion 1317-8. DOI: 10.1161/01.str.23.9.1312. View

11.

SCHETTINI A, Lippman R, Walsh E . Attenuation of decompressive hypoperfusion and cerebral edema by superoxide dismutase. J Neurosurg. 1989; 71(4):578-87. DOI: 10.3171/jns.1989.71.4.0578. View

12.

Safar P, Stezoski W, Nemoto E . Amelioration of brain damage after 12 minutes' cardiac arrest in dogs. Arch Neurol. 1976; 33(2):91-5. DOI: 10.1001/archneur.1976.00500020019004. View

13.

Vise W, Schuier F, Hossmann K, Takagi S, ZULCH K . Cerebral microembolization. I. Pathophysiological studies. Arch Neurol. 1977; 34(11):660-5. DOI: 10.1001/archneur.1977.00500230030004. View

14.

Kloner R . Does reperfusion injury exist in humans?. J Am Coll Cardiol. 1993; 21(2):537-45. DOI: 10.1016/0735-1097(93)90700-b. View

15.

Volpe B, Pulsinelli W, Tribuna J, DAVIS H . Behavioral performance of rats following transient forebrain ischemia. Stroke. 1984; 15(3):558-62. DOI: 10.1161/01.str.15.3.558. View

16.

Lee S, Vaagenes P, Safar P, Stezoski S, Scanlon M . Effect of cardiac arrest time on cortical cerebral blood flow during subsequent standard external cardiopulmonary resuscitation in rabbits. Resuscitation. 1989; 17(2):105-17. DOI: 10.1016/0300-9572(89)90063-4. View

17.

Aspey B, Jessimer C, Pereira S, Harrison M . Do leukocytes have a role in the cerebral no-reflow phenomenon?. J Neurol Neurosurg Psychiatry. 1989; 52(4):526-8. PMC: 1032310. DOI: 10.1136/jnnp.52.4.526. View

18.

KEITH F . Oxygen free radicals in cardiac transplantation. J Card Surg. 1993; 8(2 Suppl):245-8. DOI: 10.1111/j.1540-8191.1993.tb01317.x. View

19.

Hossmann K, Hossmann V . The role of cerebral blood flow for the recovery of the brain after prolonged ischemia. Z Neurol. 1973; 204(4):281-99. DOI: 10.1007/BF00316009. View

20.

Hossmann V, Hossmann K . Return of neuronal functions after prolonged cardiac arrest. Brain Res. 1973; 60(2):423-38. DOI: 10.1016/0006-8993(73)90800-7. View