Cardiopulmonary responses during the cooling and the extracorporeal life support rewarming phases in a porcine model of accidental deep hypothermic cardiac arrest

Autor: Bertrand Perrin, Angélique Brouta, Maxime Maignan, Candice Trocme, Guillaume Debaty, Vincent Bach, Stéphane Tanguy, Raphaël Briot, Dorra Guergour
Přispěvatelé: Physiologie cardio-Respiratoire Expérimentale Théorique et Appliquée (TIMC-IMAG-PRETA), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Laboratoire d'Etude et Modélisation des Environnements littoraux (LEMEL), Université de Bretagne Sud (UBS), Contrôle moléculaire de la réponse immune specifique, Université Joseph Fourier - Grenoble 1 (UJF)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de Recherche et d'Etude du Processus Inflammatoire (GREPI), Centre National de la Recherche Scientifique (CNRS)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Clinique de chirurgie cardiaque, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Cardiac output
endocrine system
Swine
medicine.medical_treatment
Resuscitation
Hemodynamics
030204 cardiovascular system & hematology
Doppler echocardiography
Critical Care and Intensive Care Medicine
Extracorporeal life support
Body Temperature
03 medical and health sciences
0302 clinical medicine
Extracorporeal Membrane Oxygenation
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Hypothermia
Induced
medicine.artery
Extracorporeal membrane oxygenation
Medicine
Animals
Rewarming
ComputingMilieux_MISCELLANEOUS
Original Research
medicine.diagnostic_test
business.industry
030208 emergency & critical care medicine
Hypothermia
Cardiac arrest
Heart Arrest
Disease Models
Animal
medicine.anatomical_structure
Blood pressure
Anesthesia
Deep hypothermic cardiac arrest
Pulmonary artery
Vascular resistance
Emergency Medicine
Female
medicine.symptom
business
Accidental hypothermia
Zdroj: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, BioMed Central, 2016, 24 (1), ⟨10.1186/s13049-016-0283-7⟩
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2016, 24 (1), ⟨10.1186/s13049-016-0283-7⟩
ISSN: 1757-7241
DOI: 10.1186/s13049-016-0283-7⟩
Popis: Background This study aimed to assess cardiac and pulmonary pathophysiological responses during cooling and extracorporeal life support (ECLS) rewarming in a porcine model of deep hypothermic cardiac arrest (DHCA). In addition, we evaluated whether providing a lower flow rate of ECLS during the rewarming phase might attenuate cardiopulmonary injuries. Methods Twenty pigs were cannulated for ECLS, cooled until DHCA occurred and subjected to 30 min of cardiac arrest. In order to assess the physiological impact of ECLS on cardiac output we measured flow in the pulmonary artery using Doppler echocardiography as well as a modified thermodilution technique using the Swan-Ganz catheter (injection site in the right ventricle). The animals were randomized into two groups during rewarming: a group with a low blood flow rate of 1.5 L/min (LF group) and a group with a normal flow rate of 3.0 L/min (NF group). The ECLS temperature was adjusted to 5 °C above the central core. Cardiac output, hemodynamics and pulmonary function parameters were evaluated. Results During the cooling phase, cardiac output, heart rhythm and blood pressure decreased continuously. Pulmonary artery pressure tended to increase at 32 °C compared to the initial value (20.2 ± 1.7 mmHg vs. 29.1 ± 5.6 mmHg, p = 0.09). During rewarming, arterial blood pressure was higher in the NF than in the LF group at 20° and 25 °C (p = 0.003 and 0.05, respectively). After rewarming to 35 °C, cardiac output was 3.9 ± 0.5 L/min in the NF group vs. 2.7 ± 0.5 L/min in LF group (p = 0.06). At the end of rewarming under ECLS cardiac output was inversely proportional to the ECLS flow rate. Moreover, the ECLS flow rate did not significantly change pulmonary vascular resistance. Discussion Using a newly developed experimental model of DHCA treated by ECLS, we assessed the cardiac and pulmonary pathophysiological response during the cooling phase and the ECLS rewarming phase. Despite lower metabolic need during hypothermia, a low ECLS blood flow rate during rewarming did not improved cardiopulmonary injuries after rewarming. Conclusion A low ECLS flow rate during the rewarming phase did not attenuate pulmonary lesions, increased blood lactate level and tended to decrease cardiac output after rewarming. A normal ECLS flow rate did not increase pulmonary vascular resistance compared to a low flow rate. This experimental model on pigs contributes a number of pathophysiological findings relevant to the rewarming strategy for patients who have undergone accidental DHCA.
Databáze: OpenAIRE
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