Cerebral cortical microvascular flow during and following cardiopulmonary resuscitation after short duration of cardiac arrest

Giuseppe Ristagno, Wanchun Tang, Shijie Sun, Max Harry Weil

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: To examine changes in cerebral cortical macro- and microcirculation and their relationship to the severity of brain ischaemia during and following resuscitation from a short duration of cardiac arrest. Methods: Bilateral cranial windows were created in eight domestic pigs weighing 41 ± 1 kg, exposing the frontoparietal cortex for orthogonal polarization spectral imaging together with estimation of cortical-tissue partial pressure of carbon dioxide, a quantitator of the severity of cerebral ischaemia. After 3 min of untreated ventricular fibrillation, cardiopulmonary resuscitation was begun and continued for 4 min before defibrillation. Aortic pressure, end-tidal and cortical-tissue partial pressure of carbon dioxide, and cortical microcirculatory blood flow in vessels of less and more than 20 μm in diameter were continuously measured. Results: Cerebral microcirculatory blood flow progressively decreased over the 3-min interval that followed onset of ventricular fibrillation. Chest compression restored cortical microvascular flow to approximately 40% of the pre-arrest value. Following return of spontaneous circulation, microvascular flow velocity was restored to baseline values over 3 min. Reversal of cerebral ischaemia with normalisation of cerebral cortical-tissue partial pressure of carbon dioxide occurred over 7 min after resuscitation. Cortical microcirculatory blood flow in microvessels less than 20 μm was highly correlated with flow in vessels more than 20 μm together with mean aortic pressure and end-tidal partial pressure of carbon dioxide. Conclusion: Cerebral cortical microcirculatory flow ceased only 3 min after onset of cardiac arrest. Flow was promptly restored to 40% of its pre-arrest value after start of chest compression. After resuscitation, both macro- and microcirculatory flows were fully restored over 3 min, but cerebral ischaemia reversed more slowly.

Original languageEnglish
Pages (from-to)229-234
Number of pages6
JournalResuscitation
Volume77
Issue number2
DOIs
Publication statusPublished - May 2008

Keywords

  • Cardiac arrest
  • Cerebral perfusion
  • CPR
  • Microcirculation
  • Tissue PCO

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

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