11 This test was performed by inflating a pneumatic cuff around the upper arm to 50 mm Hg above the systolic pressure for 3 min to follow the evolution of StO2. NIRS is a technique that utilizes near-infrared light to measure chromophores in tissues. The analysis of changes in StO2 during

a brief episode of forearm Protein Tyrosine Kinase inhibitor ischemia enables quantification of microvascular dysfunction. This vasoreactivity test evaluates a different aspect of microvascular function than flow; it evaluates microvascular oxygen uptake reserve more than actual microvascular perfusion. At baseline, the following data were recorded; general characteristics, severity of illness with Acute Physiology and Chronic Health Evaluation (APACHE) IV9 and Sequential Organ Failure Assessment (SOFA),10

Glasgow Coma Score (GCS), use of vasopressors and mechanical ventilation. Systemic hemodynamics, SDF and NIRS measurements were recorded at start study (T1), after 12 h (T2) and 24 h (T3). Length of stay in de ICU and survival status of each participant was confirmed. The moment of start study (T1) is as soon as the patient reached the targeted temperature. The primary endpoint of this study was sublingual microcirculatory blood flow as defined by microcirculatory flow index (MFI) at T1, T2 and T3. Secondary endpoints were StO2, descending and ascending slope, fluid balance after the first 24 h, use of inotropes and vasopressor dose, cardiac index, lactate, and SvO2. Bortezomib in vivo In general, all data were tested

for normal distribution with the Kolmogorov Smirnov test. Histograms and normal-quantile plots were visually inspected to verify the normality of distribution of continuous variables. First the demographic characteristics were analyzed. Variables were expressed as mean and standard deviation or medians and interquartile ranges according their distribution. Secondly, the microcirculation as the primary outcome was compared. To test differences in microcirculatory blood flow using SDF, expressed as MFI, we used the Mann–Whitney U test. To analyze differences in time courses StO2 Anova for Adenosine triphosphate repeated measurements followed by paired t-test or non-parametric was used as necessary. A Bonferroni correction was used to correct for multiple comparison. Finally the hemodynamic and biological data were compared. Variables were expressed as mean and standard deviation or medians and interquartile ranges according to their distribution. Differences between group means were tested by the student t-test or Mann–Whitney U test. A p value of <0.05 was considered statistically significant. The Statistical Package for Social Sciences (SPSS 19 for Windows, Chicago, IL, USA) is used for statistical analyses. All adult patients between March 2012 and January 2013, admitted to the ICU after an OHCA, were screened for this study. Out of 36 eligible patients 22 were included. Informed consent could not be obtained in 14 cases (see Fig. 1).