Faster Hypothermia Induced by Esophageal Cooling Improves Early Markers of Cardiac and Neurological Injury After Cardiac Arrest in Swine

Overview

Journal J Am Heart Assoc

Specialty Cardiology & Vascular Diseases

Date 2019 Jan 5

PMID 30608213

Citations 8

Authors

Jiefeng Xu

Xiaohong Jin

Qijiang Chen

Chunshuang Wu

Zilong Li

Guangju Zhou

Yongan Xu

Anyu Qian

Yulin Li

Mao Zhang

Affiliations

Soon will be listed here.

Abstract

Background After cardiopulmonary resuscitation, the protective effects of therapeutic hypothermia induced by conventional cooling are limited. Recently, esophageal cooling ( EC ) has been shown to be an effective, easily performed approach to induce therapeutic hypothermia. In this study we investigated the efficacy of EC and its effects on early markers of postresuscitation cardiac and neurological injury in a porcine model of cardiac arrest. Methods and Results Thirty-two male domestic swine were randomized into 4 groups: sham control, normothermia, surface cooling, and EC . Sham animals underwent the surgical preparation only. Ventricular fibrillation was induced and untreated for 8 minutes while defibrillation was attempted after 5 minutes of cardiopulmonary resuscitation. At 5 minutes after resuscitation, therapeutic hypothermia was induced by either EC or surface cooling to reach a target temperature of 33°C until 24 hours postresuscitation, followed by a rewarming rate of 1°C/h for 5 hours. The temperature was normally maintained in the control and normothermia groups. After resuscitation, a significantly faster decrease in blood temperature was observed in the EC group than in the surface cooling group (2.8±0.7°C/h versus 1.5±0.4°C/h; P<0.05). During the maintenance and rewarming phases the temperature was maintained at an even level between the 2 groups. Postresuscitation cardiac and neurological damage was significantly improved in the 2 hypothermic groups compared with the normothermia group; however, the protective effects were significantly greater in the EC group. Conclusions In a porcine model of cardiac arrest, faster hypothermia successfully induced by EC was significantly better than conventional cooling in improving early markers of postresuscitation cardiac and neurological injury.

Citing Articles

Clinical value of adding Dapagliflozin in patients with nephrotic syndrome.

ElSharkawy M, Emara A, Ahmed M, Ghonamy E, Teama N Int Urol Nephrol. 2024; 56(11):3617-3625.

PMID: 38862701 DOI: 10.1007/s11255-024-04099-1.

Musashi-2 causes cardiac hypertrophy and heart failure by inducing mitochondrial dysfunction through destabilizing Cluh and Smyd1 mRNA.

Singh S, Gaur A, Sharma R, Kumari R, Prakash S, Kumari S Basic Res Cardiol. 2023; 118(1):46.

PMID: 37923788 DOI: 10.1007/s00395-023-01016-y.

Message to researchers: the characteristic absence of a posterior communicating artery is easily lost in the gerbil.

Abe Y, Toyama K, Shinohara A, Nagura-Kato G, Ikai Y, Koshimoto C Anat Sci Int. 2022; 98(3):426-433.

PMID: 36472757 DOI: 10.1007/s12565-022-00698-z.

Differences in oral anticoagulant prescriptions between specialists and non-specialists in patients with cardioembolic stroke caused by non-valvular atrial fibrillation.

Deguchi I, Osada T, Arai N, Takahashi S Heart Vessels. 2021; 37(5):867-874.

PMID: 34797401 DOI: 10.1007/s00380-021-01984-y.

Prognostic value of hepatorenal function following transcatheter edge-to-edge mitral valve repair.

Tanaka T, Kavsur R, Spieker M, Iliadis C, Metze C, Horn P Clin Res Cardiol. 2021; 110(12):1947-1956.

PMID: 34254179 PMC: 8639570. DOI: 10.1007/s00392-021-01908-w.

References

Suh G, Kwon W, Kim K, Lee H, Jeong K, Jung Y . Prolonged therapeutic hypothermia is more effective in attenuating brain apoptosis in a Swine cardiac arrest model. Crit Care Med. 2013; 42(2):e132-42. DOI: 10.1097/CCM.0b013e3182a668e4. View

Goury A, Poirson F, Chaput U, Voicu S, Garcon P, Beeken T . Targeted temperature management using the "Esophageal Cooling Device" after cardiac arrest (the COOL study): A feasibility and safety study. Resuscitation. 2017; 121:54-61. DOI: 10.1016/j.resuscitation.2017.09.021. View

Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C . Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013; 369(23):2197-206. DOI: 10.1056/NEJMoa1310519. View

Yang B, Chen Y, Long Y, Fan X, Liu K, Wang X . Intestinal and Limb Ischemic Preconditioning Provides a Combined Protective Effect in the Late Phase, But not in the Early Phase, Against Intestinal Injury Induced by Intestinal Ischemia-Reperfusion in Rats. Shock. 2017; 49(5):596-603. DOI: 10.1097/SHK.0000000000000956. View

Lin S, Scales D, Dorian P, Kiss A, Common M, Brooks S . Targeted temperature management processes and outcomes after out-of-hospital cardiac arrest: an observational cohort study*. Crit Care Med. 2014; 42(12):2565-74. DOI: 10.1097/CCM.0000000000000551. View

Markota A, Fluher J, Kit B, Balazic P, Sinkovic A . The introduction of an esophageal heat transfer device into a therapeutic hypothermia protocol: A prospective evaluation. Am J Emerg Med. 2016; 34(4):741-5. DOI: 10.1016/j.ajem.2016.01.028. View

Bernard S, Smith K, Finn J, Hein C, Grantham H, Bray J . Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline: The RINSE Trial (Rapid Infusion of Cold Normal Saline). Circulation. 2016; 134(11):797-805. DOI: 10.1161/CIRCULATIONAHA.116.021989. View

Callaway C, Donnino M, Fink E, Geocadin R, Golan E, Kern K . Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2):S465-82. PMC: 4959439. DOI: 10.1161/CIR.0000000000000262. View

Chenoune M, Lidouren F, Adam C, Pons S, Darbera L, Bruneval P . Ultrafast and whole-body cooling with total liquid ventilation induces favorable neurological and cardiac outcomes after cardiac arrest in rabbits. Circulation. 2011; 124(8):901-11, 1-7. PMC: 3375236. DOI: 10.1161/CIRCULATIONAHA.111.039388. View

10.

Lilja G, Nielsen N, Friberg H, Horn J, Kjaergaard J, Nilsson F . Cognitive function in survivors of out-of-hospital cardiac arrest after target temperature management at 33°C versus 36°C. Circulation. 2015; 131(15):1340-9. DOI: 10.1161/CIRCULATIONAHA.114.014414. View

11.

Schock R, Janata A, Peacock W, Deal N, Kalra S, Sterz F . Time to Cooling Is Associated with Resuscitation Outcomes. Ther Hypothermia Temp Manag. 2016; 6(4):208-217. PMC: 5144870. DOI: 10.1089/ther.2016.0026. View

12.

Xing Z, Zeng M, Hu H, Zhang H, Hao Z, Long Y . Fragile X mental retardation protein promotes astrocytoma proliferation via the MEK/ERK signaling pathway. Oncotarget. 2016; 7(46):75394-75406. PMC: 5342749. DOI: 10.18632/oncotarget.12215. View

13.

Kulstad E, Metzger A, Courtney D, Rees J, Shanley P, Matsuura T . Induction, maintenance, and reversal of therapeutic hypothermia with an esophageal heat transfer device. Resuscitation. 2013; 84(11):1619-24. DOI: 10.1016/j.resuscitation.2013.06.019. View

14.

Laver S, Farrow C, Turner D, Nolan J . Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med. 2004; 30(11):2126-8. DOI: 10.1007/s00134-004-2425-z. View

15.

Glover G, Thomas R, Vamvakas G, Al-Subaie N, Cranshaw J, Walden A . Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest - an analysis of the TTM trial data. Crit Care. 2016; 20(1):381. PMC: 5124238. DOI: 10.1186/s13054-016-1552-6. View

16.

Lu X, Ma L, Sun S, Xu J, Zhu C, Tang W . The effects of the rate of postresuscitation rewarming following hypothermia on outcomes of cardiopulmonary resuscitation in a rat model. Crit Care Med. 2014; 42(2):e106-13. DOI: 10.1097/CCM.0b013e3182a63fff. View

17.

Kim F, Nichol G, Maynard C, Hallstrom A, Kudenchuk P, Rea T . Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA. 2013; 311(1):45-52. DOI: 10.1001/jama.2013.282173. View

18.

Dankiewicz J, Schmidbauer S, Nielsen N, Kern K, Mooney M, Stammet P . Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large prospective registry*. Crit Care Med. 2014; 42(12):2537-45. DOI: 10.1097/CCM.0000000000000543. View

19.

Guan J, Barbut D, Wang H, Li Y, Tsai M, Sun S . A comparison between head cooling begun during cardiopulmonary resuscitation and surface cooling after resuscitation in a pig model of cardiac arrest. Crit Care Med. 2010; 36(11 Suppl):S428-33. DOI: 10.1097/ccm.0b013e31818a8876. View

20.

Vaicys V, Eason A, Schieber J, Kulstad E . Therapeutic hypothermia induction via an esophageal route--a computer simulation. Am J Emerg Med. 2011; 30(6):932-5. DOI: 10.1016/j.ajem.2011.04.026. View