M Fischer1, K A Hossmann. 1. Max-Planck-Institute for Neurological Research, Department of Experimental Neurology, Köln, Germany.
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.
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.
Authors: Faisal Adhami; Guanghong Liao; Yury M Morozov; Aryn Schloemer; Vincent J Schmithorst; John N Lorenz; R Scott Dunn; Charles V Vorhees; Marsha Wills-Karp; Jay L Degen; Roger J Davis; Noboru Mizushima; Pasko Rakic; Bernard J Dardzinski; Scott K Holland; Frank R Sharp; Chia-Yi Kuan Journal: Am J Pathol Date: 2006-08 Impact factor: 4.307
Authors: Melika Hosseini; Robert H Wilson; Christian Crouzet; Arya Amirhekmat; Kevin S Wei; Yama Akbari Journal: Neurotherapeutics Date: 2020-04 Impact factor: 7.620
Authors: Elena Spinelli; Ryan P Davis; Xiaodan Ren; Parth S Sheth; Trevor R Tooley; Amit Iyengar; Brandon Sowell; Gabe E Owens; Martin L Bocks; Teresa L Jacobs; Lynda J Yang; William C Stacey; Robert H Bartlett; Alvaro Rojas-Peña; Robert W Neumar Journal: Crit Care Med Date: 2016-02 Impact factor: 7.598
Authors: Stefano G Daniele; Georg Trummer; Konstantin A Hossmann; Zvonimir Vrselja; Christoph Benk; Kevin T Gobeske; Domagoj Damjanovic; David Andrijevic; Jan-Steffen Pooth; David Dellal; Friedhelm Beyersdorf; Nenad Sestan Journal: Nat Rev Neurosci Date: 2021-07-21 Impact factor: 34.870