Mild therapeutic hypothermia is superior to controlled normothermia for the maintenance of blood pressure and cerebral oxygenation, prevention of organ damage and suppression of oxidative stress after cardiac arrest in a porcine model

Journal of Translational Medicine

Petr Neuzil⁵  Otomar Kittnar²  Hana Psotova⁵  Vlasta Dudkova¹  Ludek Taborsky³  Vladimir Hrachovina²  Jan Belohlavek⁴  Tomas Svoboda²  Frantisek Holy⁵  Marcela Skabradova⁵  Svatava Horakova⁵  Andreas Kruger⁵  Mikulas Mlcek²  Petr Ostadal⁵ 

[1] Department of Nuclear Medicine, Na Homolce Hospital, Prague, 15030, Czech Republic;Department of Physiology, First Faculty of Medicine, Charles University in Prague, Prague 12000, Czech Republic;Department of Clinical Biochemistry, Hematology, and Immunology, Na Homolce Hospital, Prague 15030, Czech Republic;2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, General University Hospital and Charles University in Prague, Prague 12000, Czech Republic;Cardiovascular Center, Na Homolce Hospital, Prague 15030, Czech Republic

关键词: Oxidative stress;    Organ protection;    Blood pressure;    Cerebral oxygenation;    Extracorporeal membrane oxygenation;    Post-cardiac arrest syndrome;    Normothermia;    Mild hypothermia;    Cardiac arrest;   

Others  :  827546
DOI  :  10.1186/1479-5876-11-124

 received in 2013-03-23, accepted in 2013-05-15,  发布年份 2013

【 摘 要 】

Background

Mild therapeutic hypothermia (HT) has been implemented in the management of post cardiac arrest (CA) syndrome after the publication of clinical trials comparing HT with common practice (ie, usually hyperthermia). Current evidence on the comparison between therapeutic HT and controlled normothermia (NT) in CA survivors, however, remains insufficient.

Methods

Eight female swine (sus scrofa domestica; body weight 45 kg) were randomly assigned to receive either mild therapeutic HT or controlled NT, with four animals per group. Veno-arterial extracorporeal membrane oxygenation (ECMO) was established and at minimal ECMO flow (0.5 L/min) ventricular fibrillation was induced by rapid ventricular pacing. After 20 min of CA, circulation was restored by increasing the ECMO flow to 4.5 L/min; 90 min of reperfusion followed. Target core temperatures (HT: 33°C; NT: 36.8°C) were maintained using the heat exchanger on the oxygenator. Invasive blood pressure was measured in the aortic arch, and cerebral oxygenation was assessed using near-infrared spectroscopy. After 60 min of reperfusion, up to three defibrillation attempts were performed. After 90 min of reperfusion, blood samples were drawn for the measurement of troponin I (TnI), myoglobin (MGB), creatine-phosphokinase (CPK), alanin-aminotransferase (ALT), neuron-specific enolase (NSE) and cystatin C (CysC) levels. Reactive oxygen metabolite (ROM) levels and biological antioxidant potential (BAP) were also measured.

Results

Significantly higher blood pressure and cerebral oxygenation values were observed in the HT group (P<0.05). Sinus rhythm was restored in all of the HT animals and in one from the NT group. The levels of TnI, MGB, CPK, ALT, and ROM were significantly lower in the HT group (P<0.05); levels of NSE, CysC, and BAP were comparable in both groups.

Conclusions

Our results from animal model of cardiac arrest indicate that HT may be superior to NT for the maintenance of blood pressure, cerebral oxygenation, organ protection and oxidative stress suppression following CA.

【 授权许可】

   
2013 Ostadal et al.; licensee BioMed Central Ltd.

【 图 表 】

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