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Background: Despite successful resuscitation with return of spontaneous circulation (ROSC), the prediction of survival in patients suffering out-of-hospital cardiac arrest (OHCA) remains difficult. Several studies have shown alterations in sublingual microcirculation in the critical ill. We hypothesized that early alterations in sublingual microcirculation may predict short-term survival after OHCA., Methods: We prospectively included all adults admitted to our university hospital between April and September 2019 with ROSC following OHCA. Sidestream dark-field microscopy to obtain sublingual microcirculation was performed at admission and after 6, 12 and 24 hours. Primary outcome was survival until discharge., Results: Twenty-five patients were included. Six hours after ROSC, the proportion of perfused small vessels (PPV small ) was lower in non-survivors than in survivors (85 ± 7.9 vs. 75 ± 6.6%; p = .01). PPV small did not correlate with serum lactate. Stratification for survival with cutoff values >78.4% for PPV small 6 h post-admission and <5.15 mmol/l for initial serum lactate as suggested by ROC-Analyses results in a positive predictive value of 100% and a negative one of 67% for our study population., Conclusion: Estimating short-term prognosis of OHCA patients with ROSC may be supported by measuring the PPV small at the sublingual microcirculation 6 hours after admission., (© 2021 The Authors. Microcirculation published by John Wiley & Sons Ltd.)