Emergency Preservation and Resuscitation with Profound Hypothermia, Oxygen, and Glucose Allows Reliable Neurological Recovery after 3 h of Cardiac Arrest from Rapid Exsanguination in Dogs

Abstract

We have used a rapid induction of profound hypothermia ( < 101C) with delayed resuscitation using cardiopulmonary bypass (CPB) as a novel approach for resuscitation from exsanguination cardiac arrest (ExCA). We have defined this approach as emergency preservation and resuscitation (EPR). We observed that 2 h but not 3 h of preservation could be achieved with favorable outcome using ice-cold normal saline flush to induce profound hypothermia. We tested the hypothesis that adding energy substrates to saline during induction of EPR would allow intact recovery after 3 h CA. Dogs underwent rapid ExCA. Two minutes after CA, EPR was induced with arterial ice-cold flush. Four treatments (n = 6/group) were defined by a flush solution with or without 2.5% glucose (G + or GÀ) and with either oxygen or nitrogen (O + or OÀ) rapidly targeting tympanic temperature of 81C. At 3 h after CA onset, delayed resuscitation was initiated with CPB, followed by intensive care to 72 h. At 72 h, all dogs in the O + G + group regained consciousness, and the group had better neurological deficit scores and overall performance categories than the OÀgroups (both P < 0.05). In the O + GÀ group, four of the six dogs regained consciousness. All but one dog in the OÀgroups remained comatose. Brain histopathology in the OÀG + was worse than the other three groups (P < 0.05). We conclude that EPR induced with a flush solution containing oxygen and glucose allowed satisfactory recovery of neurological function after a 3 h of CA, suggesting benefit from substrate delivery during induction or maintenance of a profound hypothermic CA.

Hypothermia in bleeding trauma: a friend or a foe?

“…Contemporary EPR strategies using a flush solution supplemented with oxygen and glucose can prolong life for as long as 180 minutes with adequate neurological recovery following pressure controlled hemorrhage [154]. Many questions remain and improved life-preserving strategies desired.…”

Cold aortic flush and chest compressions enable good neurologic outcome after 15 mins of ventricular fibrillation in cardiac arrest in pigs*

“…EPR is a concept derived from a dog model of exsanguination CA in which profound hypothermia (approximately 10°C) induced by aortic flush preserved brain and heart during prolonged pulselessness of up to 3 hrs, followed by de- layed resuscitation (20,(23)(24)(25)(26)(27). In the exsanguination CA model, the no-flow time before the cold flush was short (2 mins) and flush volume was nearly unlimited (up to 10 L) (26) compared to a no-flow time of 15 mins and a limited flush volume of 200 mL/kg in our VF model.…”

Effect of MRI Acoustic Noise on Cerebral Fludeoxyglucose Uptake in Simultaneous MR-PET Imaging

“…In this study we used a blood-free approach to estimate LCMRGlu using the method presented by Wu [19]. An appealing aspect of this method is that the whole brain value of each patient is normalized to a constant, which has been used in other group studies on the effects of MR on LCMRGlu [9, 10].…”

“…local cerebral metabolic rate of glucose (LCMRGlu) parametric images derived from the first 40 minutes of dynamic data using the method presented by Wu [19] [20];…”