Cardiac arrest and microcirculatory dysfunction: a narrative review.

IF 3.5 3区 医学 Q1 CRITICAL CARE MEDICINE Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-27 DOI:10.1097/MCC.0000000000001219
Max S Kravitz, John H Lee, Nathan I Shapiro
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Abstract

Purpose of review: This review provides an overview of the role of microcirculation in cardiac arrest and postcardiac arrest syndrome through handheld intravital microscopy and biomarkers. It highlights the importance of microcirculatory dysfunction in postcardiac arrest outcomes and explores potential therapeutic targets.

Recent findings: Sublingual microcirculation is impaired in the early stage of postarrest and is potentially associated with increased mortality. Recent work suggests that the proportion of perfused small vessels is predictive of mortality. Microcirculatory impairment is consistently found to be independent of macrohemodynamic parameters. Biomarkers of endothelial cell injury and endothelial glycocalyx degradation are elevated in postarrest settings and may predict mortality and clinical outcomes, warranting further studies. Recent studies of exploratory therapies targeting microcirculation have shown some promise in animal models but still require significant research.

Summary: Although research continues to suggest the important role that microcirculation may play in postcardiac arrest syndrome and cardiac arrest outcomes, the existing studies are still limited to draw any definitive conclusions. Further research is needed to better understand microcirculatory changes and their significance to improve cardiac arrest care and outcomes.

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心脏骤停与微循环功能障碍:叙述性综述。
综述的目的:本综述通过手持式体内显微镜和生物标志物概述了微循环在心脏骤停和心脏骤停后综合征中的作用。它强调了微循环功能障碍在心脏骤停后结果中的重要性,并探讨了潜在的治疗目标:最近的研究结果:在心跳骤停后的早期阶段,舌下微循环受损,可能与死亡率增加有关。最近的研究表明,灌注小血管的比例可预测死亡率。微循环损伤一直与宏观血流动力学参数无关。内皮细胞损伤和内皮糖萼降解的生物标志物在心搏骤停后升高,可预测死亡率和临床结果,值得进一步研究。最近针对微循环的探索性疗法的研究在动物模型中显示出一定的前景,但仍需要大量的研究。总结:尽管研究继续表明微循环可能在心脏骤停后综合征和心脏骤停预后中扮演重要角色,但现有的研究仍然有限,无法得出任何明确的结论。要更好地了解微循环变化及其对改善心脏骤停护理和预后的意义,还需要进一步的研究。
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来源期刊
Current Opinion in Critical Care
Current Opinion in Critical Care 医学-危重病医学
CiteScore
5.90
自引率
3.00%
发文量
172
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​​​Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.
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