Persistent microperfusion alterations after return of spontaneous circulation (ROSC) are associated with poor survival. To our knowledge, no human studies evaluating microperfusion during cardiopulmonary resuscitation (CPR) with simple and pre-hospital available tests have been published. Capillary refill time (CRT) and skin-mottling-score (SMS) are parameters for microperfusion and evaluated in septic and cardiogenic shock. In animal studies, microperfusion was impaired during cardiac arrest, although not correlating with systemic blood pressure. The aim of this study is to investigate the correlation between impaired microcirculation (as measured with CRT and SMS) during resuscitation and ROSC resp. neurological outcome. Our clinical impression in daily routine is, that the appearance of a patient undergoing CPR is often linked to the outcome. We hypothesize, that this is due to changes in microperfusion of the skin.
Study Type
OBSERVATIONAL
Enrollment
50
Vienna Municipal Emergency Service
Vienna, Austria
Capillary refill time (CRT)
Capillary refill time in seconds measured on one finger and one earlobe for ROSC vs. no ROSC
Time frame: baseline (immediately after inclusion to the study)
Skin mottling score (SMS)
Skin mottling score (Ait-Oufella, H., Lemoinne, S., Boelle, P.Y. et al. Mottling score predicts survival in septic shock. Intensive Care Med 37, 801-807 (2011). Best: 0 - no mottling to worst: 5 - mottling on the entire leg) for ROSC vs. noROSC
Time frame: baseline (immediately after inclusion to the study = minute 0), minute 2, 4, 6, 8, (...) up to return of spontaneous circulation or death, whichever came first
Capillary blood lactate (Lac)
Capillary lactate in mmol/L from the capillary bed of a finger for ROSC vs noROSC and for correlations with CRT, SMS
Time frame: baseline (immediately after inclusion to the study, = minute 0), minute 4, 8, 12, 16, 20
Hospital mortality
Correlation of CRT, SMS and Lac with hospital mortality
Time frame: baseline (immediately after inclusion to the study)
Correlation of CRT, SMS and Lac and 30 days good neurological outcome
Good neurological outcome at 30 days measured with Cerebral Performance Category (CPC 1-5 (1 best: good cerebral performance, 5 worst: brain dead), modified Rankin scale (mRs 0-6 (0 best: no symptoms, 6 worst: dead) and health utility index 3 (HUI-3, worst: -0,36 - best: 1)
Time frame: baseline (immediately after inclusion to the study)
Correlation of CRT, SMS and Lac and hospital discharge good neurological outcome
Good neurological outcome at hospital discharge measured with Cerebral Performance Category (CPC 1-5 (1 best: good cerebral performance, 5 worst: brain dead), modified Rankin scale (mRs 0-6 (0 best: no symptoms, 6 worst: dead) and health utility index 3 (HUI-3, worst: -0,36 - best: 1)
Time frame: baseline (immediately after inclusion to the study)
Correlation of CRT/SMS and lactate
Correlation of CRT/SMS and lactate
Time frame: baseline (immediately after inclusion to the study)
Correlation of SMS and CRT
Correlation of SMS and CRT
Time frame: baseline (immediately after inclusion to the study)
Correlation of time since cardiac arrest and CRT/SMS/lactate
Correlation of time since cardiac arrest and CRT/SMS/lactate
Time frame: baseline (immediately after inclusion to the study)
Correlation of catecholamine demand during the first 48 hours after ROSC and CRT/SMS
Cumulative catecholamine demand during the first 48 hours after ROSC in correlation with CRT/SMS/Lac during resuscitation
Time frame: from ROSC up to 48 hours after ROSC
Capillary refill time (CRT)
Capillary refill time in seconds measured on one finger and one earlobe for ROSC vs. no ROSC
Time frame: minute 2, 4, 6, 8, (...) up to return of spontaneous circulation or death, whichever came first
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