Rapid induction of hypothermia with a small volume aortic flush during cardiac arrest in pigs

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• 作者：Wolfgang Weihs ; DVM^a ; Danica Krizanac ; MD^a ; Fritz Sterz ; MD^a ; ^{fritz.sterz@meduniwien.ac.at} ; Gerald Hlavin^b ; Andreas Janata ; MD^a ; Wolfgang Sipos ; DVM^c ; Michael Holzer ; MD^a ; Udo M. Losert ; DVM^d ; Wilhelm Behringer ; MD^a
• 刊名：The American Journal of Emergency Medicine
• 出版年：2012
• 期刊代码：316_07356757
• 类别：med
• 出版时间：June, 2012
• 卷：30
• 期：5
• 页码：643-650
• 文件大小：572 K

摘要

Purpose

The induction of deep cerebral hypothermia (15掳C) via large-volume cold (4掳C) saline aortic flush during cardiac arrest and resuscitation with cardiopulmonary bypass improves neurologic outcome in pigs. We hypothesized that induction of mild cerebral hypothermia (33掳C) via smaller volume and resuscitation without bypass will improve survival and neurologic outcome after 15 minutes of cardiac arrest as compared with conventional resuscitation attempts.

Basic Procedures

Twenty-four pigs (29-38 kg) underwent ventricular fibrillation cardiac arrest for 15 minutes. Conventional resuscitation (n = 8) was compared with hypothermic (4掳C, n = 8) and normothermic (38.5掳C, n = 8) aortic flush (30 mL/kg) at the beginning of resuscitation efforts, with defibrillation attempts 2 minutes later. Outcomes after 9 days were compared.

Main Findings

In the hypothermic flush group, brain temperature decreased from 38.3掳C 卤 0.5掳C to 33掳C 卤 0.5掳C within 277 卤 112 seconds. We observed considerably higher mean coronary perfusion pressures in the normothermic and hypothermic flush groups (hypothermic vs conventional, P = .023; normothermic vs conventional, P = .041). Three animals of each flush group, compared with none of the conventional group, achieved restoration of spontaneous circulation (P = .2); and 3 pigs of the hypothermic flush group and 2 pigs of the normothermic flush group survived to 9 days without differences in neurologic outcome.

Principal Conclusion

A smaller volume, cold saline aortic flush during prolonged cardiac arrest rapidly induces mild cerebral hypothermia to 33掳C and improves coronary perfusion pressure but does not result in a significant improvement in outcome as compared with conventional resuscitation attempts.