Rapid Hypothermic Aortic Flush Can Achieve Survival without Brain Damage after 30 Minutes Cardiac Arrest in Dogs

Behringer, Wilhelm; Prueckner, Stephan; Kentner, Rainer; Tisherman, Samuel A.; Radovsky, Ann; Clark, Robert S. B.; Stezoski, S. William; Henchir, Jeremy; Klein, Edwin; Šafář, Peter

doi:10.1097/00000542-200012000-00022

Cited by 73 publications

(43 citation statements)

References 2 publications

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“…However, many questions regarding hypothermia remain to be addressed, and recently some clinical studies have questioned the effectiveness of hypothermia for traumatic brain injury. 14 In view of these considerations and the positive reports about hypothermia treatment in stroke victims, 15 we decided to extend our studies to include the carotid artery to test the hypothesis of a cooling-induced vasodilatation of brain supply vessels.…”

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Cooling-Induced Carotid Artery Dilatation

Mustafa

Thulesius

2002

Stroke

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Background and Purpose-Clinical and experimental studies seem to indicate that hypothermia may improve outcome in stroke victims and reduce experimental brain injury. The current interpretation is that cooling has a neuroprotective effect by reducing brain metabolism. The objective of our study was to test the hypothesis that hypothermia induces arterial vasodilatation and thereby increases cerebral blood flow. Methods-We recorded isometric tension in rabbit carotid artery strips in organ baths during stepwise cooling. The cooling responses were tested at basal tone, in noradrenaline-precontracted vessels, and after electric field stimulation. Results-Stepwise cooling from 37°C to 4°C induced reproducible graded relaxation, inversely proportional to temperature. The responses could be elicited at basal tone and in precontracted vessels. Cooling decreased the contractile responses to norepinephrine and potassium chloride. Cooling at 20°C decreased the contractile responses to electric field stimulation, while at 10°C these were totally abolished. Cooling-induced vasodilatation is not dependent on an endothelial mechanism. Key Words: carotid arteries Ⅲ hypothermia Ⅲ ischemia Ⅲ neuroprotection Ⅲ stroke W e previously studied thermal responses of smooth muscle in various species and organs of the body and found that the degree of active tension is very temperature dependent. Moreover, we detected marked regional differences in the cooling-response pattern in superficial and deep blood vessels, trachea, bronchi, urinary bladder detrusor muscle, and gut. Cutaneous veins contract, whereas deep extremity vessels dilate. 1 The aorta and pulmonary artery clearly show a cooling-induced relaxation, 2 whereas airways, 3 urinary bladder, 4 and gut contract. 5 As a treatment, hypothermia has been advocated as a potent modality in protecting neurons against lethal ischemic stress. In animal experiments, intraischemic hypothermia has been shown to be neuroprotective in global 6 and focal 7-9 cerebral ischemia and even when hypothermia is initiated after temporary cerebral ischemia. 10 Kuluz et al 11 found that selective brain cooling increases cortical cerebral blood flow. Conclusions-CoolingIt has been claimed that mild hypothermia is possibly the single most effective method of cerebroprotection developed to date. 12 Krieger et al 13 recently reported that hypothermia is effective in patients with acute brain infarction, demonstrating that hypothermia appears feasible and safe in cases of acute ischemic stroke even after thrombolysis. However, many questions regarding hypothermia remain to be addressed, and recently some clinical studies have questioned the effectiveness of hypothermia for traumatic brain injury. 14 In view of these considerations and the positive reports about hypothermia treatment in stroke victims, 15 we decided to extend our studies to include the carotid artery to test the hypothesis of a cooling-induced vasodilatation of brain supply vessels. Materials and MethodsAll procedures followed were within insti...

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Cooling-Induced Carotid Artery Dilatation

Mustafa

Thulesius

2002

Stroke

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“…Normothermic exsanguination over 5 min led to CA no flow for periods ranging between 15 min and 120 min -CA at various temperatures (57,60,61). Preservation was induced within the first 5 min of C A by flushing isotonic NaCl (saline) into the aorta via a balloon catheter, with or without special drugs or fluids added.…”

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confidence: 99%

“…We systematically extended the CA (no flow) period from 20 min (54), to 30 min (60), and to 60-120 min (61,62). The lower the Tty after flush the better was preservation for increasing CA duration.…”

Section: Approachmentioning

confidence: 99%

“…A delay in flush during normothermic CA to 8 min no flow before start of cold flush negated the preservation achieved with flush starting at CA 2 min or 5 min (84). When we increased CA to 30 min no flow (60), we found that the flush volume of saline at 4°C had to be increased to 100 nuVkg to achieve functionally normal brains, and in some dogs even histologically normal brains; the aortic balloon had to be inflated in the abdominal aorta to also protect the viscera and spinal cord against ischemic damage (60,61,62). For flush preservation in adult humans (70 kg), this translates to 7L of iced saline.…”

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confidence: 99%

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Novel Resuscitation from Lethal Hemorrhage. Increasing Survival of Combat Casualties

Šafář¹,

Tisherman²

2001

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“…5,6 We used EPR to achieve intact survival of dogs after rapid hemorrhage (over 5 minutes) and cardiac arrest. [5][6][7][8][9] The success of EPR relies on the timely initiation of preservation during cardiac arrest. When 30-minute EPR was…”

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Induction of Profound Hypothermia for Emergency Preservation and Resuscitation Allows Intact Survival After Cardiac Arrest Resulting From Prolonged Lethal Hemorrhage and Trauma in Dogs

Drábek

Kochanek

et al. 2006

Circulation

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Background-Induction of profound hypothermia for emergency preservation and resuscitation (EPR) of trauma victims who experience exsanguination cardiac arrest may allow survival from otherwise-lethal injuries. Previously, we achieved intact survival of dogs from 2 hours of EPR after rapid hemorrhage. We tested the hypothesis that EPR would achieve good outcome if prolonged hemorrhage preceded cardiac arrest. Methods and Results-Two minutes after cardiac arrest from prolonged hemorrhage and splenic transection, dogs were randomized into 3 groups (nϭ7 each): (1) the cardiopulmonary resuscitation (CPR) group, resuscitated with conventional CPR, and the (2) EPR-I and (3) EPR-II groups, both of which received 20 L of a 2°C saline aortic flush to achieve a brain temperature of 10°C to 15°C. CPR or EPR lasted 60 minutes and was followed in all groups by a 2-hour resuscitation by cardiopulmonary bypass. Splenectomy was then performed. The CPR dogs were maintained at 38.0°C. In the EPR groups, mild hypothermia (34°C) was maintained for either 12 (EPR-I) or 36 (EPR-II) hours. Function and brain histology were evaluated 60 hours after rewarming in all dogs. Cardiac arrest occurred after 124Ϯ16 minutes of hemorrhage. In the CPR group, spontaneous circulation could not be restored without cardiopulmonary bypass; none survived. Twelve of 14 EPR dogs survived. Compared with the EPR-I group, the EPR-II group had better overall performance, final neurological deficit scores, and histological damage scores. Conclusions-EPR is superior to conventional CPR in facilitating normal recovery after cardiac arrest from trauma and prolonged hemorrhage. Prolonged mild hypothermia after EPR was critical for achieving intact neurological outcomes.

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Rapid Hypothermic Aortic Flush Can Achieve Survival without Brain Damage after 30 Minutes Cardiac Arrest in Dogs

Abstract: A single high-volume flush of cold saline (4 degrees C) into the abdominal aorta given 2 min after the onset of cardiac arrest rapidly induces moderate-to-deep cerebral hypothermia and can result in survival without functional or histologic brain damage, even after 30 min of no blood flow.

Cited by 73 publications

References 2 publications

Cooling-Induced Carotid Artery Dilatation

Cooling-Induced Carotid Artery Dilatation

Novel Resuscitation from Lethal Hemorrhage. Increasing Survival of Combat Casualties

Induction of Profound Hypothermia for Emergency Preservation and Resuscitation Allows Intact Survival After Cardiac Arrest Resulting From Prolonged Lethal Hemorrhage and Trauma in Dogs

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