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

Alexandra M. Marquez, Marinos Kosmopoulos, Rajat Kalra, Tomaz Goslar, Deborah Jaeger, Christopher Gaisendrees, Alejandra Gutierrez, Gregory Carlisle, Tamas Alexy, Sergey Gurevich, Andrea M. Elliott, Marie E. Steiner, Jason A. Bartos, Davis Seelig, Demetris Yannopoulos

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article number100745
JournalResuscitation Plus
Volume19
DOIs
StatePublished - Sep 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors

Keywords

  • Cardiac arrest
  • ECMO
  • ECPR
  • Hypothermia
  • Resuscitation
  • Temperature

PubMed: MeSH publication types

  • Journal Article

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