Mild (34 °C) versus moderate hypothermia (24 °C) in a swine model of extracorporeal cardiopulmonary resuscitation.

Autor:	Marquez AM; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA., Kosmopoulos M; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.; Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Kalra R; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.; Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Goslar T; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA., Jaeger D; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA., Gaisendrees C; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA., Gutierrez A; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.; Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Carlisle G; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA., Alexy T; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.; Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Gurevich S; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.; Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Elliott AM; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.; Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Steiner ME; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.; Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA., Bartos JA; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.; Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Seelig D; Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Minneapolis, MN, USA., Yannopoulos D; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.; Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Jazyk:	angličtina
Zdroj:	Resuscitation plus [Resusc Plus] 2024 Aug 16; Vol. 19, pp. 100745. Date of Electronic Publication: 2024 Aug 16 (Print Publication: 2024).
DOI:	10.1016/j.resplu.2024.100745
Abstrakt:	Background: The role of hypothermia in post-arrest neuroprotection is controversial. Animal studies suggest potential benefits with lower temperatures, but high-fidelity ECPR models evaluating temperatures below 30 °C are lacking. Objectives: To determine whether rapid cooling to 24 °C initiated upon reperfusion reduces brain injury compared to 34 °C in a swine model of ECPR. Methods: Twenty-four female pigs had electrically induced VF and mechanical CPR for 30 min. Animals were cannulated for VA-ECMO and cooled to either 34 °C for 4 h (n = 8), 24 °C for 1 h with rewarming to 34 °C over 3 h (n = 7), or 24 °C for 4 h without rewarming (n = 9). Cooling was initiated upon VA-ECMO reperfusion by circulating ice water through the oxygenator. Brain temperature and cerebral and systemic hemodynamics were continuously monitored. After four hours on VA-ECMO, brain tissue was obtained for examination. Results: Target brain temperature was achieved within 30 min of reperfusion (p = 0.74). Carotid blood flow was higher in the 24 °C without rewarming group throughout the VA-ECMO period compared to 34 °C and 24 °C with rewarming (p < 0.001). Vasopressin requirement was higher in animals treated with 24 °C without rewarming (p = 0.07). Compared to 34 °C, animals treated with 24 °C with rewarming were less coagulopathic and had less immunohistochemistry-detected neurologic injury. There were no differences in global brain injury score. Conclusions: Despite improvement in carotid blood flow and immunohistochemistry detected neurologic injury, reperfusion at 24 °C with or without rewarming did not reduce early global brain injury compared to 34 °C in a swine model of ECPR. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (© 2024 The Authors.)
Databáze:	MEDLINE
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