Hypothermic Aortic Arch Flush for Preservation during Exsanguination Cardiac Arrest of 15 Minutes in Dogs

Abstract

At the start of 15 minutes of exsanguination cardiac arrest in dogs, hypothermic aortic arch flush allows resuscitation to survival with normal neurologic function and histologically almost clean brains.

Novel Resuscitation from Lethal Hemorrhage. Increasing Survival of Combat Casualties

“…For that we are advising industries to work on novel vessel-access methods -insertion of an aortic balloon catheter percutaneously, through cutdown or via thoracotomy (Dr. Klain, Dr. Yaffe, Cardeon Co.); and for a miniaturized cooling/pumping device. In our dog outcome studies (see "approach") the aortic balloon catheter was placed in the upper thoracic aorta to first rapidly preserve brain and heart Starting at CA 2 min normothermic no flow, normothermic flush of 500 ml at 37.5°C over 1 min did not improve outcome (53,65); however, the same with saline at 24°C achieved brain (tympanic membrane) temperature (Tty) 36°C; and saline flush at 4°C achieved Tty 34°C, all within 1-3 min flush (53). Flush with 24°C saline at start of CA 15 min noflow achieved functional normality at 72 h, but with histologic damage (53).…”

“…In our dog outcome studies (see "approach") the aortic balloon catheter was placed in the upper thoracic aorta to first rapidly preserve brain and heart Starting at CA 2 min normothermic no flow, normothermic flush of 500 ml at 37.5°C over 1 min did not improve outcome (53,65); however, the same with saline at 24°C achieved brain (tympanic membrane) temperature (Tty) 36°C; and saline flush at 4°C achieved Tty 34°C, all within 1-3 min flush (53). Flush with 24°C saline at start of CA 15 min noflow achieved functional normality at 72 h, but with histologic damage (53). Flush with 4°C saline (Tty 34°C) at start of CA 15 min achieved functional and histologic normality (53).…”

“…In years 1-2, we modified our past SA model (50,51) which used CPB for induction of preservation (SA) at the start of CA with profound Hth. In the modification, the induction of SA was with a single flush of cold saline via an aortic balloon catheter (53). This method is likely to be more feasible than CPB in the field or in field hospitals.…”

“…Flush with 24°C saline at start of CA 15 min noflow achieved functional normality at 72 h, but with histologic damage (53). Flush with 4°C saline (Tty 34°C) at start of CA 15 min achieved functional and histologic normality (53). Catheter design influenced outcome; with the opening at the tip, the straight flush resulted in better outcome than using a catheter with the tip closed and the flush through multiple lateral openings.…”

Therapeutic hypothermia after cardiac arrest

“…Cardiopulmonary bypass is used only for resuscitation and rewarming [49,50 ]. In a series of experiments, dogs were exsanguinated over 5 min to cardiac arrest no-flow of duration 15-120 min [51][52][53]54 ]. At 2 min of cardiac arrest, the dogs received the aortic flush via a balloon-tipped catheter, advanced via the femoral artery.…”