Debaty Guillaume, Maignan Maxime, Perrin Bertrand, Brouta Angélique, Guergour Dorra, Trocme Candice, Bach Vincent, Tanguy Stéphane, Briot Raphaël
University Grenoble Alps, CNRS, TIMC-IMAG UMR 5525, Team PRETA, Grenoble, France.
Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, Grenoble, France.
Acad Emerg Med. 2016 Jun;23(6):665-73. doi: 10.1111/acem.12893. Epub 2016 Feb 13.
Extracorporeal life support (ECLS) is the reference rewarming technique of accidental deep hypothermic cardiac arrest (DHCA). This study was designed to examine the impact of different rewarming blood flow rates and temperature setting of ECLS on cardiopulmonary lesions after DHCA in a porcine model of accidental hypothermia.
Twenty-four pigs were cannulated for ECLS, cooled until DHCA occurred, and subjected to 30 minutes of cardiac arrest. During the rewarming phase, we compared a low blood flow rate of 1.5 L/min versus a high flow rate of 3.0 L/min as well as two-temperature-setting rewarming strategies: a temperature during ECLS adjusted to 5°C above the central core temperature versus 38°C maintained throughout the rewarming phase. Cardiac output, hemodynamics and pulmonary function parameters were evaluated. Biologic markers of ischemia-reperfusion injuries were analyzed at baseline and at the end of the experiment.
DHCA occurred at 21.2 ± 2°C. There was a trend for better cardiac output in groups with high blood flow (p = 0.053), with no interaction between ECLS flow and temperature (p = 0.63), a trend toward lower pulmonary vascular resistance (PVR; p = 0.075) and a significant decrease in arterial PVR in groups with high blood flow (p = 0.013) with no interaction (p = 0.47 and p = 0.60 for PVR and arterial PVR, respectively). Serum interleukin-6, tumor necrosis factor-α, receptor for advanced glycation end products (RAGE), and neuron-specific enolase were significantly increased between baseline and endpoint. The increase in the serum RAGE concentration was higher in the 38°C rewarming temperature groups compared to 5°C above adjusted temperature. There were no other significant differences in biomarkers.
We developed a porcine model of DHCA treated by ECLS. Our data suggest that cardiac output tended to improve with a high-flow-rate rewarming strategy while a high-temperature delta between core temperature and ECLS increased the RAGE markers of lung injury.
体外生命支持（ECLS）是意外性深度低温心脏骤停（DHCA）的标准复温技术。本研究旨在探讨在意外低温猪模型中，不同的ECLS复温血流速率和温度设置对DHCA后心肺损伤的影响。
24头猪接受ECLS插管，冷却至发生DHCA，并经历30分钟心脏骤停。在复温阶段，我们比较了1.5 L/min的低血流速率与3.0 L/min的高血流速率，以及两种温度设置的复温策略：ECLS期间的温度调整为比中心体温高5°C，与在整个复温阶段维持38°C。评估心输出量、血流动力学和肺功能参数。在基线和实验结束时分析缺血再灌注损伤的生物学标志物。
DHCA发生时体温为21.2±2°C。高血流组的心输出量有改善趋势（p = 0.053），ECLS血流与温度之间无相互作用（p = 0.63），肺血管阻力（PVR）有降低趋势（p = 0.075），高血流组的动脉PVR显著降低（p = 0.013），无相互作用（PVR和动脉PVR的p分别为0.47和0.60）。血清白细胞介素-6、肿瘤坏死因子-α、晚期糖基化终产物受体（RAGE）和神经元特异性烯醇化酶在基线和终点之间显著增加。与调整温度以上5°C相比，38°C复温温度组的血清RAGE浓度升高更高。生物标志物无其他显著差异。
我们建立了一种用ECLS治疗的DHCA猪模型。我们的数据表明，高血流速率复温策略倾向于改善心输出量，而核心体温与ECLS之间的高温差增加了肺损伤的RAGE标志物。
