Slow versus fast rewarming after hypothermic circulatory arrest: effects on neuroinflammation and cerebral oedema
Autor: | Marco Anderloni, Maddalena Tessari, Alessio Rungatscher, Pietro Bontempi, Stiljan Hoxha, Ilaria Decimo, Romel Mani, Elena Nicolato, Beat H. Walpoth, Giovanni Battista Luciani, Flavia Merigo, Angela Murari, Sissi Dolci, Giuseppe Faggian, Daniele Linardi |
---|---|
Rok vydání: | 2020 |
Předmět: |
Pulmonary and Respiratory Medicine
Necrosis Brain Edema 030204 cardiovascular system & hematology Hypothermic circulatory arrest Cerebral edema law.invention Rats Sprague-Dawley 03 medical and health sciences 0302 clinical medicine Hypothermia Induced law Cerebral perfusion Cardiopulmonary bypass Neurological outcome Rewarming medicine Animals Cerebral perfusion pressure Neuroinflammation Cardiopulmonary Bypass medicine.diagnostic_test business.industry Brain Magnetic resonance imaging General Medicine medicine.disease Rats Cerebral blood flow Cerebrovascular Circulation Anesthesia Circulatory system Heart Arrest Induced Surgery medicine.symptom Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
Zdroj: | European Journal of Cardio-Thoracic Surgery. 58:792-800 |
ISSN: | 1873-734X 1010-7940 |
Popis: | OBJECTIVESAmong the factors that could determine neurological outcome after hypothermic circulatory arrest (HCA) rewarming is rarely considered. The optimal rewarming rate is still unknown. The goal of this study was to investigate the effects of 2 different protocols for rewarming after HCA on neurological outcome in an experimental animal model.METHODSForty-four Sprague Dawley rats were cooled to 19 ± 1°C body core temperature by cardiopulmonary bypass (CPB). HCA was maintained for 60 min. Animals were randomized to receive slow (90 min) or fast (45 min) assisted rewarming with CPB to a target temperature of 35°C. After a total of 90 min of reperfusion in both groups, brain samples were collected and analysed immunohistochemically and with immunofluorescence. In 10 rats, magnetic resonance imaging was performed after 2 and after 24 h to investigate cerebral perfusion and cerebral oedema.RESULTSInterleukin 6, chemokine (C-C motif) ligand 5, intercellular adhesion molecule 1 and tumour necrosis factor α in the hippocampus are significantly less expressed in the slow rewarming group, and microglia cells are significantly less activated in the slow rewarming group. Magnetic resonance imaging analysis demonstrated better cerebral perfusion and less water content in brains that underwent slow rewarming at 2 and 24 h.CONCLUSIONSSlow rewarming after HCA might be superior to fast rewarming in neurological outcome. The present experimental study demonstrated reduction in the inflammatory response, reduction of inflammatory cell activation in the brain, enhancement of cerebral blood flow and reduction of cerebral oedema when slow rewarming was applied. |
Databáze: | OpenAIRE |
Externí odkaz: |