The Rate of Induction of Hypothermic Arrest Determines the Outcome in a Swine Model of Lethal Hemorrhage

Abstract

Hypothermic metabolic arrest can be used to maintain viability of key organs during repair of lethal injuries. Survival is influenced by the rate of cooling with the best outcome following rapid induction of hypothermia.

Prolonged deep hypothermic circulatory arrest in rats can be achieved without cognitive deficits

“…Fentanyl was found to be neither protective nor neurotoxic in the presence of concurrent anoxic injury (Charchaflieh et al, 1998), although results are controversial (Kofke et al, 1999(Kofke et al, , 1996 and some have shown neurotoxicity with fentanyl vs. isoflurane in cerebral ischemia (Miura et al, 1998). The rate of cooling (Alam et al, 2004) and rewarming (Alam et al, 2006) as well as subtle difference in intraischemic temperature (Mujsce et al, 1994) could also impact the outcome.…”

Profound Hypothermia Protects Neurons and Astrocytes, and Preserves Cognitive Functions in a Swine Model of Lethal Hemorrhage1

“…Furthermore, by using a realistic model (uncontrolled hemorrhage, open body cavities, major vascular injuries, operative trauma, repair of lethal injuries), and by monitoring for delayed complications, our study has added the much needed clinical relevance. The intra-operative hemodynamic changes, post-operative organ functions (non-CNS), and survival data has been reported separately [19]. Briefly, the oxygen delivery was minimal (Ͻ50 ml/min), and total body oxygen consumption was non-measurable during the 60 min of asangenous profound hypothermic arrest.…”

“…The data obtained from this study were divided into two complimentary manuscripts for ease of presentation. The first manuscript described the physiological changes during hypothermic arrest, performance of non-CNS organs, and post-operative complications [19]. The current manuscript provides detailed information about the central nervous system in these animals.…”

Hypothermic Blood Substitution: Special Considerations for Protection of Cells during ex vivo and in vivo Preservation

“…More importantly, they showed that profound hypothermia could be used successfully, even after 60 min of normothermic shock, and that the surviving animals were not only neurologically intact but also had normal cognitive functions. Subsequent studies showed that the best outcomes were achieved using rapid induction of hypothermia (2 °C/min) and a slower rate of reversal (0.5 °C/min warming) [70,86]. Moreover, these studies using Unisol solutions for implementing HBS demonstrated the preservation of various cell types in the central nervous system, in addition to providing some immunological advantages [87,88].…”

“…These solutions have been shown to protect the brain, heart and visceral organs during Taylor 3.5 h of cardiac arrest and global ischemia in an asanguineous canine model during controlled profound hypothermia at <10 °C [1,34,55] . More recently, this approach has been applied experimentally to animal models (porcine and canine) of hemorrhagic shock discussed more fully below [62,63,[67][68][69][70].…”