Emergency preservation and resuscitation with profound hypothermia, oxygen, and glucose allows reliable neurological recovery after 3 h of cardiac arrest from rapid exsanguination in dogs.

Abstract

We have used a rapid induction of profound hypothermia (<10 degrees C) with delayed resuscitation using cardiopulmonary bypass (CPB) as a novel approach for resuscitation from exsanguination cardiac arrest (ExCA). We have defined this approach as emergency preservation and resuscitation (EPR). We observed that 2 h but not 3 h of preservation could be achieved with favorable outcome using ice-cold normal saline flush to induce profound hypothermia. We tested the hypothesis that adding energy substrates to saline during induction of EPR would allow intact recovery after 3 h CA. Dogs underwent rapid ExCA. Two minutes after CA, EPR was induced with arterial ice-cold flush. Four treatments (n=6/group) were defined by a flush solution with or without 2.5% glucose (G+ or G-) and with either oxygen or nitrogen (O+ or O-) rapidly targeting tympanic temperature of 8 degrees C. At 3 h after CA onset, delayed resuscitation was initiated with CPB, followed by intensive care to 72 h. At 72 h, all dogs in the O+G+ group regained consciousness, and the group had better neurological deficit scores and overall performance categories than the O-groups (both P<0.05). In the O+G- group, four of the six dogs regained consciousness. All but one dog in the O-groups remained comatose. Brain histopathology in the O-G+ was worse than the other three groups (P<0.05). We conclude that EPR induced with a flush solution containing oxygen and glucose allowed satisfactory recovery of neurological function after a 3 h of CA, suggesting benefit from substrate delivery during induction or maintenance of a profound hypothermic CA.

• Authors: Xianren Wu, Tomas Drabek, Samuel A Tisherman, Jeremy Henchir, S William Stezoski, Sherman Culver, Jason Stezoski, Edwin K Jackson, Robert Garman, Patrick M Kochanek
• Journal: Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism (J Cereb Blood Flow Metab) Vol. 28 Issue 2 Pg. 302-11 (Feb 2008) ISSN: 0271-678X [Print] United States
• PMID: 17622254 (Publication Type: Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Glucose
• Oxygen

Topics

• Animals
• Body Temperature (physiology)
• Brain (pathology)
• Cardiopulmonary Bypass
• Cardiopulmonary Resuscitation
• Consciousness (physiology)
• Critical Care
• Dogs
• Emergency Medical Services
• Glucose (administration & dosage, therapeutic use)
• Heart Arrest (complications, therapy)
• Hypothermia, Induced
• Male
• Nervous System Diseases (etiology, pathology, therapy)
• Oxygen (administration & dosage, therapeutic use)
• Treatment Outcome