Foerster Katharina, Benk Christoph, Beyersdorf Friedhelm, Cristina Schmitz Heidi, Wittmann Karin, Taunyane Itumeleng, Heilmann Claudia, Trummer Georg
Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany.
Perfusion. 2018 May;33(4):270-277. doi: 10.1177/0267659117742478. Epub 2017 Nov 10.
Cardiopulmonary resuscitation restores circulation, but with inconsistent blood-flow and pressures. Our recent approach using an extracorporeal life support system, named "controlled integrated resuscitation device" (CIRD), may lead to improved survival and neurological recovery after cardiac arrest (CA). The basic idea is to provide a reperfusion tailored to the individual patient by control of the conditions of reperfusion and the composition of the reperfusate. Hypothermia is one aspect of this concept. Here, we investigated the role of immediate short-term blood cooling after experimental CA and its influence on survival and neurological recovery.
Twenty-one pigs were exposed to 20 minutes of normothermic CA. Afterwards, CIRD was immediately started for 60 minutes in all animals and the heart was converted to a sinus rhythm. The pigs either received normothermic reperfusion (37°C, n=11) or the temperature was maintained at 32°C for the first 30 minutes (n=10). Thermometric, hemodynamic and serologic data were collected during the experiment. After weaning from CIRD, neurological recovery was assessed daily by a species-specific neurological deficit score (NDS; 0: normal; 500: brain death).
One pig in each group could not be successfully resuscitated. Due to severe neurological deficits, only 6/11 animals in the normothermic group finished the observation time of seven days with an NDS of 37±34. In the hypothermic group, all nine surviving animals reached day seven with an NDS of 16±13. Analogous to the lower NDS, animals in the hypothermic group also showed lower neuron-specific enolase end values as a marker of brain injury.
Within this experimental setting, immediate moderate and short-term hypothermia after CA improves survival and seems to result in statistically non-significant better neurological recovery.
心肺复苏可恢复循环，但血流和压力并不稳定。我们最近采用体外生命支持系统的方法，即“可控整合复苏装置”（CIRD），可能会提高心脏骤停（CA）后的生存率和神经功能恢复情况。其基本理念是通过控制再灌注条件和再灌注液成分，为个体患者提供量身定制的再灌注治疗。低温是这一概念的一个方面。在此，我们研究了实验性CA后立即进行短期血液降温的作用及其对生存和神经功能恢复的影响。
21头猪接受20分钟的常温CA。之后，所有动物立即启动CIRD持续60分钟，心脏恢复窦性心律。这些猪要么接受常温再灌注（37°C，n = 11），要么在最初30分钟将温度维持在32°C（n = 10）。实验过程中收集温度、血流动力学和血清学数据。从CIRD撤机后，每天通过特定物种的神经功能缺损评分（NDS；0：正常；500：脑死亡）评估神经功能恢复情况。
每组各有1头猪未能成功复苏。由于严重的神经功能缺损，常温组中只有6/11的动物完成了7天的观察期，NDS为37±34。在低温组中，所有9只存活的动物在第7天达到了NDS为16±13。与较低的NDS类似，低温组动物作为脑损伤标志物的神经元特异性烯醇化酶终值也较低。
在本实验环境中，CA后立即进行适度短期低温可提高生存率，似乎还能使神经功能恢复在统计学上有不显著的改善。
