Intensive Care Medicine

, Volume 21, Issue 2, pp 132–141

No-reflow after cardiac arrest

  • M. Fischer
  • K. -A. Hossmann

DOI: 10.1007/BF01726536

Cite this article as:
Fischer, M. & Hossmann, K.A. Intensive Care Med (1995) 21: 132. doi:10.1007/BF01726536



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.


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, noreflow 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.).


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 postresuscitation brain pathology.

Key words

Brain resuscitation Cardiac arrest Cerebral ischemia Closed chest cardiac massage Microcirculation No-reflow 

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • M. Fischer
    • 1
  • K. -A. Hossmann
    • 1
  1. 1.Department of Experimental NeurologyMax-Planck-Institute for Neurological ResearchKölnGermany

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