Hangzhou Emergency Medical Center of Zhejiang Province, Zhejiang, Hangzhou, China.
Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China; Institute of Emergency Medicine, Zhejiang University, Zhejiang, Hangzhou, China.
Am J Emerg Med. 2021 Sep;47:231-238. doi: 10.1016/j.ajem.2021.04.057. Epub 2021 Apr 23.
Continuous renal replacement therapy (CRRT) was currently demonstrated to be an effective way to induce fast hypothermia and had proective effects on cardiac dysfunction and brain damage after cardiac pulmonary resuscitation (CPR). In the present study, we aimed to investigate the influence of extracorporeal circuit cooling using CRRT on renal and intestinal damage after CPR based on a porcine model.
32 pigs were subjected to ventricular fibrillation for 8 min, followed by CPR for 5 min before defibrillation. All were randomized to receive extracorporeal circuit cooling using CRRT (CRRT, n = 9), surface cooling (SC, n = 9), normothermia (NT, n = 9) or sham control (n = 5) at 5 min post resuscitation. Pigs in the CRRT group were cooled by 8-h CRRT cooling with the infusion line initially submerged in 4 °C of ice water and 16-h SC, while in the SC group by a 24-h SC. Temperatures were maintained at a normal range in the other two groups. Biomarkers in serum were measured at baseline and 1, 3, 6, 12, 24 and 30 h post resuscitation to assess organ functions. Additionally, tissues of kidney and intestine were harvested, from which the degree of tissue inflammation, oxidative stress, and apoptosis levels were analyzed.
The blood temperature decreased faster by extracorporeal circuit cooling using CRRT than SC (9.8 ± 1.6 vs. 1.5 ± 0.4 °C/h, P < 0.01). Post-resuscitation renal and intestinal injury were significantly improved in the 2 hypothermic groups compared to the NT group. And the improvement was significantly greater in animals received extracorporeal circuit cooling than those received surface cooling, from both the results of biomarkers in serum and pathological evidence.
Fast hypothermia induced by extracorporeal circuit cooling was superior to. surface cooling in mitigating renal and intestinal injury post resuscitation.
连续肾脏替代疗法（CRRT）目前被证明是一种诱导快速降温的有效方法，对心肺复苏（CPR）后心脏功能障碍和脑损伤具有保护作用。在本研究中，我们旨在基于猪模型研究 CPB 体外循环冷却对 CPR 后肾和肠损伤的影响。
32 头猪进行心室颤动 8 分钟，然后进行 5 分钟的 CPR 后除颤。所有动物随机分为接受 CRRT（CRRT，n = 9）、表面冷却（SC，n = 9）、常温（NT，n = 9）或假对照（n = 5）治疗，复苏后 5 分钟开始治疗。CRRT 组在 8 小时 CRRT 冷却下冷却，初始将输注管浸入 4°C 的冰水中，并进行 16 小时的 SC，而 SC 组则进行 24 小时的 SC。其他两组的温度维持在正常范围内。在复苏后 1、3、6、12、24 和 30 小时测量血清中的生物标志物，以评估器官功能。此外，还采集了肾脏和肠道组织，分析组织炎症、氧化应激和细胞凋亡水平。
与 SC 相比，CRRT 体外循环冷却可更快地降低血液温度（9.8 ± 1.6 与 1.5 ± 0.4°C/h，P < 0.01）。与 NT 组相比，2 个低温组在复苏后肾和肠道损伤均有明显改善。与接受表面冷却的动物相比，接受体外循环冷却的动物的改善更为显著，无论是血清生物标志物还是病理证据均如此。
CRRT 体外循环冷却诱导的快速降温在减轻复苏后肾和肠道损伤方面优于表面冷却。
