Selective brain hypothermia: feasibility and safety study of a novel method in five patients
| Autor: | David F. Kallmes, Seyed Mohammad Seyedsaadat, James Anderson, D. Daly, Silvana Marasco, Thomas Kreck, Seth Rodgers, Robin McEgan, Ramanathan Kadirvel |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty therapeutic hypothermia Common method 030204 cardiovascular system & hematology Neuroprotection 03 medical and health sciences 0302 clinical medicine Hypothermia Induced Humans Medicine Radiology Nuclear Medicine and imaging Prospective Studies cardiac surgical procedures Stroke Aged Aged 80 and over Advanced and Specialized Nursing circulatory arrest business.industry Brain Ischemic injury General Medicine Middle Aged Hypothermia medicine.disease Original Papers stroke Cardiac surgery Brain Injuries Anesthesia Feasibility Studies Female neuroprotection medicine.symptom Cardiology and Cardiovascular Medicine business Safety Research 030217 neurology & neurosurgery heart arrest |
| Zdroj: | Perfusion |
| ISSN: | 1477-111X 0267-6591 |
| Popis: | Background/objective: Reduction of brain temperature remains the most common method of neuroprotection against ischemic injury employed during cardiac surgery. However, cooling delivered via the cardiopulmonary bypass circuit is brief and cooling the body core along with the brain has been associated with a variety of unwanted effects. This study investigated the feasibility and safety of a novel selective brain cooling approach to induce rapid, brain-targeted hypothermia independent of the cardiopulmonary bypass circuit. Methods: This first-in-human feasibility study enrolled five adults undergoing aortic valve replacement with cardiopulmonary bypass support. During surgery, the NeuroSave system circulated chilled saline within the pharynx and upper esophagus. Brain and body core temperature were continuously monitored. Adverse effects, cardiopulmonary function, and device function were noted. Results: Patient 1 received cooling fluid for an insignificant period, and Patients 2-5 successfully underwent the cooling procedure using the NeuroSave system for 56-89 minutes. Cooling fluid was 12°C for Patients 1-3, 6°C for Patient 4, and 2°C for Patient 5. There were no NeuroSave-related adverse events and no alterations in cardiopulmonary function during NeuroSave use. Brain temperature decreased by 3°C within 15 minutes and remained at least 3.5°C colder than the body core. During a brief episode of hypotension in one patient, the brain cooled an additional 4°C in 2 minutes, briefly reaching 27.4°C. Conclusion: The NeuroSave system can induce rapid brain-targeted hypothermia and simultaneously maintain a favorable body–brain temperature gradient, even during hypotension. Further studies are required to evaluate the function of the system during longer periods of use. |
| Databáze: | OpenAIRE |
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