Marquez Alexandra M, Kosmopoulos Marinos, Kalra Rajat, Goslar Tomaz, Jaeger Deborah, Gaisendrees Christopher, Gutierrez Alejandra, Carlisle Gregory, Alexy Tamas, Gurevich Sergey, Elliott Andrea M, Steiner Marie E, Bartos Jason A, Seelig Davis, Yannopoulos Demetris
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
Resusc Plus. 2024 Aug 16;19:100745. doi: 10.1016/j.resplu.2024.100745. eCollection 2024 Sep.
The role of hypothermia in post-arrest neuroprotection is controversial. Animal studies suggest potential benefits with lower temperatures, but high-fidelity ECPR models evaluating temperatures below 30 °C are lacking.
To determine whether rapid cooling to 24 °C initiated upon reperfusion reduces brain injury compared to 34 °C in a swine model of ECPR.
Twenty-four female pigs had electrically induced VF and mechanical CPR for 30 min. Animals were cannulated for VA-ECMO and cooled to either 34 °C for 4 h (n = 8), 24 °C for 1 h with rewarming to 34 °C over 3 h (n = 7), or 24 °C for 4 h without rewarming (n = 9). Cooling was initiated upon VA-ECMO reperfusion by circulating ice water through the oxygenator. Brain temperature and cerebral and systemic hemodynamics were continuously monitored. After four hours on VA-ECMO, brain tissue was obtained for examination.
Target brain temperature was achieved within 30 min of reperfusion (p = 0.74). Carotid blood flow was higher in the 24 °C without rewarming group throughout the VA-ECMO period compared to 34 °C and 24 °C with rewarming (p < 0.001). Vasopressin requirement was higher in animals treated with 24 °C without rewarming (p = 0.07). Compared to 34 °C, animals treated with 24 °C with rewarming were less coagulopathic and had less immunohistochemistry-detected neurologic injury. There were no differences in global brain injury score.
Despite improvement in carotid blood flow and immunohistochemistry detected neurologic injury, reperfusion at 24 °C with or without rewarming did not reduce early global brain injury compared to 34 °C in a swine model of ECPR.
低温在心脏骤停后神经保护中的作用存在争议。动物研究表明较低温度可能有益，但缺乏评估低于30°C温度的高保真体外心肺复苏（ECPR）模型。
在猪ECPR模型中，确定与34°C相比，再灌注时快速冷却至24°C是否能减少脑损伤。
24只雌性猪经电诱导室颤并进行机械心肺复苏30分钟。动物接受VA-ECMO插管，并分别冷却至34°C持续4小时（n = 8）、24°C持续1小时并在3小时内复温至34°C（n = 7）或24°C持续4小时不复温（n = 9）。通过使冰水在氧合器中循环，在VA-ECMO再灌注时开始冷却。持续监测脑温以及脑和全身血流动力学。在VA-ECMO支持4小时后，获取脑组织进行检查。
再灌注后30分钟内达到目标脑温（p = 0.74）。在整个VA-ECMO期间，24°C不复温组的颈动脉血流量高于34°C组和24°C复温组（p < 0.001）。24°C不复温处理的动物血管加压素需求量更高（p = 0.07）。与34°C相比，24°C复温处理的动物凝血功能障碍较轻，免疫组化检测到的神经损伤较少。全脑损伤评分无差异。
在猪ECPR模型中，尽管颈动脉血流量有所改善且免疫组化检测到神经损伤减轻，但24°C复温或不复温再灌注与34°C相比，并未减少早期全脑损伤。
