Selective brain cooling in infant piglets after cardiac arrest and resuscitation

Barry Gelman, Charles L. Schleien, Abhijit Lohe, John W. Kuluz

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Objectives: To test the hypothesis that selective brain cooling could be performed in an infant model of cardiac arrest and resuscitation without changing core temperature and to study its acute effects on regional organ blood flow, cerebral metabolism, and systemic hemodynamics. Design: Prospective, randomized, controlled study. Setting: Research laboratory at a university medical center. Subjects: Fourteen healthy infant piglets, weighing 3.5 to 6.0 kg. Interventions: Piglets were anesthetized and mechanically ventilated, and had vascular catheters placed. Parietal cortex (superficial brain), caudate nucleus (deep brain), esophageal, and rectal temperatures were monitored. All animals underwent 6 mins of cardiac arrest induced by ventricular fibrillation, 6 mins of external cardiopulmonary resuscitation (CPR), defibrillation, and 2 hrs of reperfusion. Normal core temperature (rectal) was regulated in all animals. In seven control animals (group 1), brain temperature was not manipulated. In seven experimental animals (group 2), selective brain cooling was begun during CPR, using a cooling cap filled with -30°C solution. Selective brain cooling was continued for 45 mins of reperfusion, after which passive rewarming was allowed. Regional blood flow (microspheres) and arterial and sagittal sinus blood gases were measured prearrest, during CPR, and at 10 mins, 45 mins, and 2 hrs of reperfusion. Measurements and Main Results: Rectal temperature did not change over time in either group. In group 1, brain temperature remained constant except for a decrease of 0.6°C at 10 mins of reperfusion. In group 2, superficial and deep brain temperatures were lowered to 32.8±0.7 (SEM) °C and 34.9±0.4°C, respectively, by 15 mins of reperfusion. Superficial and deep brain temperatures were further lowered to 27.8±0.8°C and 31.1±0.3°C, respectively, at 45 mins of reperfusion. Both temperatures returned to baseline by 120 mins. Cerebral blood flow was not different between groups at any time point, although there was a trend for higher flow in group 2 at 10 mins of reperfusion (314% of baseline) compared with group 1 (230% of baseline). Cerebral oxygen uptake was lower in group 2 than in group 1 (69% vs. 44% of baseline, p = .02) at 45 mins of reperfusion. During CPR, aortic diastolic pressure was lower in group 2 than in group 1 (27±1 vs. 23±1 mm Hg, p = .007). Myocardial blood flow during CPR was also lower in group 2 (80±7 vs. 43±7 mL/min/100 g, p = .002). Kidney and intestinal blood flows were reduced during CPR in both groups; however, group 2 animals also had lower intestinal flow vs. group 1 at 45 and 120 mins of reperfusion. Conclusions: Selective brain cooling by surface cooling can be achieved rapidly in an infant animal model of cardiac arrest and resuscitation without changing core temperature. Brain temperatures known to improve neurologic outcome can be achieved by this technique with minimal adverse effects. Because of its ease of application, selective brain cooling may prove to be an effective, inexpensive method of cerebral resuscitation during pediatric CPR.

Original languageEnglish
Pages (from-to)1009-1017
Number of pages9
JournalCritical Care Medicine
Volume24
Issue number6
DOIs
StatePublished - Jun 1 1996

Fingerprint

Heart Arrest
Resuscitation
Reperfusion
Cardiopulmonary Resuscitation
Temperature
Brain
Regional Blood Flow
Cerebrovascular Circulation
Rewarming
Vascular Access Devices
Induced Heart Arrest
Parietal Lobe
Caudate Nucleus
Ventricular Fibrillation
Microspheres
Nervous System
Healthy Volunteers
Arterial Pressure
Animal Models
Gases

Keywords

  • blood flow, cerebral
  • cardiopulmonary resuscitation
  • cerebral ischemia
  • neurologic emergencies
  • pediatrics
  • reperfusion
  • temperature

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Selective brain cooling in infant piglets after cardiac arrest and resuscitation. / Gelman, Barry; Schleien, Charles L.; Lohe, Abhijit; Kuluz, John W.

In: Critical Care Medicine, Vol. 24, No. 6, 01.06.1996, p. 1009-1017.

Research output: Contribution to journalArticle

Gelman, Barry ; Schleien, Charles L. ; Lohe, Abhijit ; Kuluz, John W. / Selective brain cooling in infant piglets after cardiac arrest and resuscitation. In: Critical Care Medicine. 1996 ; Vol. 24, No. 6. pp. 1009-1017.
@article{40f638009f4b4af693681cd818bbd674,
title = "Selective brain cooling in infant piglets after cardiac arrest and resuscitation",
abstract = "Objectives: To test the hypothesis that selective brain cooling could be performed in an infant model of cardiac arrest and resuscitation without changing core temperature and to study its acute effects on regional organ blood flow, cerebral metabolism, and systemic hemodynamics. Design: Prospective, randomized, controlled study. Setting: Research laboratory at a university medical center. Subjects: Fourteen healthy infant piglets, weighing 3.5 to 6.0 kg. Interventions: Piglets were anesthetized and mechanically ventilated, and had vascular catheters placed. Parietal cortex (superficial brain), caudate nucleus (deep brain), esophageal, and rectal temperatures were monitored. All animals underwent 6 mins of cardiac arrest induced by ventricular fibrillation, 6 mins of external cardiopulmonary resuscitation (CPR), defibrillation, and 2 hrs of reperfusion. Normal core temperature (rectal) was regulated in all animals. In seven control animals (group 1), brain temperature was not manipulated. In seven experimental animals (group 2), selective brain cooling was begun during CPR, using a cooling cap filled with -30°C solution. Selective brain cooling was continued for 45 mins of reperfusion, after which passive rewarming was allowed. Regional blood flow (microspheres) and arterial and sagittal sinus blood gases were measured prearrest, during CPR, and at 10 mins, 45 mins, and 2 hrs of reperfusion. Measurements and Main Results: Rectal temperature did not change over time in either group. In group 1, brain temperature remained constant except for a decrease of 0.6°C at 10 mins of reperfusion. In group 2, superficial and deep brain temperatures were lowered to 32.8±0.7 (SEM) °C and 34.9±0.4°C, respectively, by 15 mins of reperfusion. Superficial and deep brain temperatures were further lowered to 27.8±0.8°C and 31.1±0.3°C, respectively, at 45 mins of reperfusion. Both temperatures returned to baseline by 120 mins. Cerebral blood flow was not different between groups at any time point, although there was a trend for higher flow in group 2 at 10 mins of reperfusion (314{\%} of baseline) compared with group 1 (230{\%} of baseline). Cerebral oxygen uptake was lower in group 2 than in group 1 (69{\%} vs. 44{\%} of baseline, p = .02) at 45 mins of reperfusion. During CPR, aortic diastolic pressure was lower in group 2 than in group 1 (27±1 vs. 23±1 mm Hg, p = .007). Myocardial blood flow during CPR was also lower in group 2 (80±7 vs. 43±7 mL/min/100 g, p = .002). Kidney and intestinal blood flows were reduced during CPR in both groups; however, group 2 animals also had lower intestinal flow vs. group 1 at 45 and 120 mins of reperfusion. Conclusions: Selective brain cooling by surface cooling can be achieved rapidly in an infant animal model of cardiac arrest and resuscitation without changing core temperature. Brain temperatures known to improve neurologic outcome can be achieved by this technique with minimal adverse effects. Because of its ease of application, selective brain cooling may prove to be an effective, inexpensive method of cerebral resuscitation during pediatric CPR.",
keywords = "blood flow, cerebral, cardiopulmonary resuscitation, cerebral ischemia, neurologic emergencies, pediatrics, reperfusion, temperature",
author = "Barry Gelman and Schleien, {Charles L.} and Abhijit Lohe and Kuluz, {John W.}",
year = "1996",
month = "6",
day = "1",
doi = "10.1097/00003246-199606000-00022",
language = "English",
volume = "24",
pages = "1009--1017",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Selective brain cooling in infant piglets after cardiac arrest and resuscitation

AU - Gelman, Barry

AU - Schleien, Charles L.

AU - Lohe, Abhijit

AU - Kuluz, John W.

PY - 1996/6/1

Y1 - 1996/6/1

N2 - Objectives: To test the hypothesis that selective brain cooling could be performed in an infant model of cardiac arrest and resuscitation without changing core temperature and to study its acute effects on regional organ blood flow, cerebral metabolism, and systemic hemodynamics. Design: Prospective, randomized, controlled study. Setting: Research laboratory at a university medical center. Subjects: Fourteen healthy infant piglets, weighing 3.5 to 6.0 kg. Interventions: Piglets were anesthetized and mechanically ventilated, and had vascular catheters placed. Parietal cortex (superficial brain), caudate nucleus (deep brain), esophageal, and rectal temperatures were monitored. All animals underwent 6 mins of cardiac arrest induced by ventricular fibrillation, 6 mins of external cardiopulmonary resuscitation (CPR), defibrillation, and 2 hrs of reperfusion. Normal core temperature (rectal) was regulated in all animals. In seven control animals (group 1), brain temperature was not manipulated. In seven experimental animals (group 2), selective brain cooling was begun during CPR, using a cooling cap filled with -30°C solution. Selective brain cooling was continued for 45 mins of reperfusion, after which passive rewarming was allowed. Regional blood flow (microspheres) and arterial and sagittal sinus blood gases were measured prearrest, during CPR, and at 10 mins, 45 mins, and 2 hrs of reperfusion. Measurements and Main Results: Rectal temperature did not change over time in either group. In group 1, brain temperature remained constant except for a decrease of 0.6°C at 10 mins of reperfusion. In group 2, superficial and deep brain temperatures were lowered to 32.8±0.7 (SEM) °C and 34.9±0.4°C, respectively, by 15 mins of reperfusion. Superficial and deep brain temperatures were further lowered to 27.8±0.8°C and 31.1±0.3°C, respectively, at 45 mins of reperfusion. Both temperatures returned to baseline by 120 mins. Cerebral blood flow was not different between groups at any time point, although there was a trend for higher flow in group 2 at 10 mins of reperfusion (314% of baseline) compared with group 1 (230% of baseline). Cerebral oxygen uptake was lower in group 2 than in group 1 (69% vs. 44% of baseline, p = .02) at 45 mins of reperfusion. During CPR, aortic diastolic pressure was lower in group 2 than in group 1 (27±1 vs. 23±1 mm Hg, p = .007). Myocardial blood flow during CPR was also lower in group 2 (80±7 vs. 43±7 mL/min/100 g, p = .002). Kidney and intestinal blood flows were reduced during CPR in both groups; however, group 2 animals also had lower intestinal flow vs. group 1 at 45 and 120 mins of reperfusion. Conclusions: Selective brain cooling by surface cooling can be achieved rapidly in an infant animal model of cardiac arrest and resuscitation without changing core temperature. Brain temperatures known to improve neurologic outcome can be achieved by this technique with minimal adverse effects. Because of its ease of application, selective brain cooling may prove to be an effective, inexpensive method of cerebral resuscitation during pediatric CPR.

AB - Objectives: To test the hypothesis that selective brain cooling could be performed in an infant model of cardiac arrest and resuscitation without changing core temperature and to study its acute effects on regional organ blood flow, cerebral metabolism, and systemic hemodynamics. Design: Prospective, randomized, controlled study. Setting: Research laboratory at a university medical center. Subjects: Fourteen healthy infant piglets, weighing 3.5 to 6.0 kg. Interventions: Piglets were anesthetized and mechanically ventilated, and had vascular catheters placed. Parietal cortex (superficial brain), caudate nucleus (deep brain), esophageal, and rectal temperatures were monitored. All animals underwent 6 mins of cardiac arrest induced by ventricular fibrillation, 6 mins of external cardiopulmonary resuscitation (CPR), defibrillation, and 2 hrs of reperfusion. Normal core temperature (rectal) was regulated in all animals. In seven control animals (group 1), brain temperature was not manipulated. In seven experimental animals (group 2), selective brain cooling was begun during CPR, using a cooling cap filled with -30°C solution. Selective brain cooling was continued for 45 mins of reperfusion, after which passive rewarming was allowed. Regional blood flow (microspheres) and arterial and sagittal sinus blood gases were measured prearrest, during CPR, and at 10 mins, 45 mins, and 2 hrs of reperfusion. Measurements and Main Results: Rectal temperature did not change over time in either group. In group 1, brain temperature remained constant except for a decrease of 0.6°C at 10 mins of reperfusion. In group 2, superficial and deep brain temperatures were lowered to 32.8±0.7 (SEM) °C and 34.9±0.4°C, respectively, by 15 mins of reperfusion. Superficial and deep brain temperatures were further lowered to 27.8±0.8°C and 31.1±0.3°C, respectively, at 45 mins of reperfusion. Both temperatures returned to baseline by 120 mins. Cerebral blood flow was not different between groups at any time point, although there was a trend for higher flow in group 2 at 10 mins of reperfusion (314% of baseline) compared with group 1 (230% of baseline). Cerebral oxygen uptake was lower in group 2 than in group 1 (69% vs. 44% of baseline, p = .02) at 45 mins of reperfusion. During CPR, aortic diastolic pressure was lower in group 2 than in group 1 (27±1 vs. 23±1 mm Hg, p = .007). Myocardial blood flow during CPR was also lower in group 2 (80±7 vs. 43±7 mL/min/100 g, p = .002). Kidney and intestinal blood flows were reduced during CPR in both groups; however, group 2 animals also had lower intestinal flow vs. group 1 at 45 and 120 mins of reperfusion. Conclusions: Selective brain cooling by surface cooling can be achieved rapidly in an infant animal model of cardiac arrest and resuscitation without changing core temperature. Brain temperatures known to improve neurologic outcome can be achieved by this technique with minimal adverse effects. Because of its ease of application, selective brain cooling may prove to be an effective, inexpensive method of cerebral resuscitation during pediatric CPR.

KW - blood flow, cerebral

KW - cardiopulmonary resuscitation

KW - cerebral ischemia

KW - neurologic emergencies

KW - pediatrics

KW - reperfusion

KW - temperature

UR - http://www.scopus.com/inward/record.url?scp=0029941774&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029941774&partnerID=8YFLogxK

U2 - 10.1097/00003246-199606000-00022

DO - 10.1097/00003246-199606000-00022

M3 - Article

VL - 24

SP - 1009

EP - 1017

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 6

ER -