Intra-arrest selective brain cooling improves success of resuscitation in a porcine model of prolonged cardiac arrest

Abstract Aims of study We have previously demonstrated that early intra-nasal cooling improved post-resuscitation neurological outcomes. The present study utilizing a porcine model of prolonged cardiac arrest investigated the effects of intra-nasal cooling initiated at the start of cardiopulmonary r...

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Bibliographic Details
Published in:Resuscitation 2010-05, Vol.81 (5), p.617-621
Main Authors: Wang, Hao, Barbut, Denise, Tsai, Min-Shan, Sun, Shijie, Weil, Max Harry, Tang, Wanchun
Format: Article
Language:English
Subjects:
Administration, Intranasal
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Animals
Biological and medical sciences
Body Temperature
Brain - physiopathology
Cardiac arrest
Cardiopulmonary Resuscitation - methods
Cold Temperature
Disease Models, Animal
Electric Countershock
Emergency
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Heart Arrest - etiology
Heart Arrest - physiopathology
Heart Arrest - therapy
Hypothermia
Hypothermia, Induced - methods
Intensive care medicine
Intra-nasal cooling
Male
Medical sciences
Pulmonary Artery - physiopathology
Resuscitation
ROSC
Swine
Time Factors
Treatment Outcome
Ventricular Fibrillation - complications
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Summary:Abstract Aims of study We have previously demonstrated that early intra-nasal cooling improved post-resuscitation neurological outcomes. The present study utilizing a porcine model of prolonged cardiac arrest investigated the effects of intra-nasal cooling initiated at the start of cardiopulmonary resuscitation (CPR) on resuscitation success. Our hypothesis was that rapid nasal cooling initiated during “low-flow” improves return of spontaneous resuscitation (ROSC). Methods In 16 domestic male pigs weighing 40 ± 3 kg, VF was electrically induced and untreated for 15 min. Animals were randomized to either head cooling or control. CPR was initiated and continued for 5 min before defibrillation was attempted. Coincident with starting CPR, the hypothermic group was cooled with a RhinoChill™ device which produces evaporative cooling in the nasal cavity of pigs. No cooling was administrated to control animals. If ROSC was not achieved after defibrillation, CPR was resumed for 1 min prior to the next defibrillation attempt until either successful resuscitation or for a total of 15 min. Main results Seven of eight animals in the hypothermic group (87.5%) and two of eight animals in control group (25%) ( p = 0.04) were successfully resuscitated. At ROSC, brain temperature was increased from baseline by 0.3 °C in the control group, and decreased by 0.1 °C in the hypothermic animals. Pulmonary artery temperature was above baseline in both groups. Conclusion Intra-nasal cooling initiated at the start of CPR significantly improves the success of resuscitation in a porcine model of prolonged cardiac arrest. This may have occurred by preventing brain hyperthermia.
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2010.01.027