Department of Cardiovascular Surgery, General Hospital of Shenyang Military Command, Shenyang, 110016 China.
Department of Forensic Medicine, National Police University of China, Liaoning, 110035 China.
Mil Med Res. 2017 May 30;4:16. doi: 10.1186/s40779-017-0127-4. eCollection 2017.
The successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia-induced suspended animation for delayed resuscitation (SADR) is a novel approach for inducing cardiac arrest and buying additional time for such injuries. However, the time used to safely administer circulatory arrest (CA) is controversial. The goal of this study was to evaluate the safety of hypothermia-induced SADR over 90 and 120 min time intervals.
Sixteen male BAMA minipigs were randomized into two groups: CA90 group (90 min, = 8) and CA120 group (120 min, = 8). Cannulation of the right common carotid arteries and internal jugular veins was performed to establish cardiopulmonary bypass for each animal. Through the perfusion of cold organ preservation solution (OPS), cardioplegia and profound hypothermia (15 °C) were induced. After CA, cardiopumonary bypass (CPB) was restarted, and the animals were gradually re-warmed and resuscitated. The animals were assisted with ventilators until spontaneous breathing was achieved. The index of hemodynamic perioperative serum chemistry values [alanine transaminase (ALT), aspartate aminotransferase (AST), creatinine (CR), lactic dehydrogenase (LDH) and troponin T (TnT)] and survival were observed from pre-operation to 7 days post-operation.
Fifteen animals were enrolled in the experiment, while 1 animal in CA120 group died from surgical error. All 8 animals in CA90 group recovered, with only 1 animal displaying mild disability. However, in CA120 group, only 2 animals survived with severe disability, and the other 5 animals died after 2 days post-operation. In CA90 group, the perioperative serum chemistry values increased at 1 day post-operation (ALT 84.43 ± 18.65 U/L; AST 88.99 ± 23.19 U/L; Cr 87.90 ± 24.49 μmol/L; LDH 1894.13 ± 322.26 U/L; TnT 0.849 ± 0.135 ng/ml) but decreased to normal or almost normal levels at 7 days post-operation (ALT 52.48 ± 9.04 U/L; AST 75.23 ± 21.46 U/L; Cr 82.69 ± 18.41 μmol/L; LDH 944.67 ± 834.32 U/L; TnT 0.336 ± 0.076 ng/ml).
Profound hypothermia-induced SADR is an effective method for inducing cardiac arrest. Our results indicate that inducing CA for 90 min (at 15 °C) is safer than doing so for 120 min. Our results indicate that 120 min of CA at 15 °C is dangerous and can result in high mortality and severe neurological complications. Further experimentation is needed to determine whether 120 min of CA at temperatures lower than 15 °C can lead to safe recovery.
军事战斗穿透性伤害伤员的成功治疗在很大程度上取决于将患者送往适当治疗设施所需的时间。延迟复苏的深度低温诱导暂停生命（SADR）是一种诱导心脏骤停并为此类伤害争取额外时间的新方法。然而，安全实施停循环（CA）所需的时间存在争议。本研究的目的是评估 90 和 120 分钟时间间隔内诱导 SADR 的安全性。
16 只雄性 BAMA 小型猪被随机分为两组：CA90 组（90 分钟，n=8）和 CA120 组（120 分钟，n=8）。为每只动物进行右颈总动脉和颈内静脉插管，以建立心肺旁路。通过灌注冷器官保存液（OPS）、心脏停搏液和深度低温（15°C）诱导 SADR。CA 后，重启心肺旁路（CPB），并逐渐复温并复苏动物。动物使用呼吸机辅助呼吸，直至自主呼吸恢复。观察从术前到术后 7 天的围手术期血清化学值[丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、肌酐（CR）、乳酸脱氢酶（LDH）和肌钙蛋白 T（TnT）]和存活率的指标。
15 只动物被纳入实验，而 CA120 组的 1 只动物因手术错误死亡。CA90 组的 8 只动物全部恢复，只有 1 只动物表现出轻度残疾。然而，在 CA120 组中，只有 2 只动物存活且严重残疾，其余 5 只动物在术后 2 天死亡。在 CA90 组中，术后 1 天血清化学值升高（ALT 84.43±18.65 U/L；AST 88.99±23.19 U/L；Cr 87.90±24.49 μmol/L；LDH 1894.13±322.26 U/L；TnT 0.849±0.135 ng/ml），但在术后 7 天恢复正常或接近正常水平（ALT 52.48±9.04 U/L；AST 75.23±21.46 U/L；Cr 82.69±18.41 μmol/L；LDH 944.67±834.32 U/L；TnT 0.336±0.076 ng/ml）。
深度低温诱导 SADR 是诱导心脏骤停的有效方法。我们的结果表明，在 15°C 下诱导 CA 90 分钟比 120 分钟更安全。我们的结果表明，在 15°C 下诱导 CA 120 分钟是危险的，会导致高死亡率和严重的神经并发症。需要进一步的实验来确定在 15°C 以下的温度下进行 120 分钟的 CA 是否可以安全恢复。
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