With the presented navigator-gated and real-time motion corrected sequence for MR-imaging of myocardial late enhancement data can be completely acquired during free-breathing. Time constraints of a breath-hold technique are abolished and optimized patient specific inversion time is ensured.

Methods We assessed safety and feasibility of trans-nasal cooling in a multi-centre, single-arm descriptive study of comatose patients who had been successfully resuscitated after cardiac arrest. Forty three patients were treated with a non-invasive cooling device through which cooling was achieved via trans-nasal delivery of an evaporative coolant into the nasopharynx. Initial temperatures, course of cooling, and systemic and local adverse events during cooling were documented. Patients were treated with nasal cooling until they either reached target temperature or were transitioned to treatment according to local standard protocols. Primary outcome was speed of cooling. Survival and cerebral performance category (CPC) at hospital discharge were recorded. Results Data are presented as mean ± SD or median (interquartile range (25, 75%)). Mean age was 71.1 ± 10.8 years. VF was the first documented rhythm in 52.4% of the patients, asystole in 31.0%. Temperatures at admission were 35.2±1.2°C tympanic, 35.5±1.1°C, core (arterial or esophageal), and 35.9±1.0°C, bladder. Time from the start of cooling to target temperature (33°C) was 50.0 (35.0 – 68.3) minutes tympanic, and 72.5 (17.3–146.3) minutes, core. Cooling rate of tympanic temperature was 2.4°C/hr., core cooling rate was 1.4°C/hr and bladder 0.9°C/hr. Adverse events affecting the nasal area occurred in 9/43 patients, resolved in 8 (78%) patients spontaneously. One had persistent damage at death, 18 hours later. Systemic adverse events were consistent with the patient population being treated. Twelve patients (30%) had a CPC of 1–2. Twenty-three patients (57.5%) died, none related to the hypothermia procedure, and five patients (12.5%) had a poor outcome. In patients with VF, eight patients (40%) had a CPC of 1–2, eight patients died and four patients had poor outcome. Conclusions Trans-nasal cooling for induction of therapeutic hypothermia in patients after successful resuscitation from cardiac arrest is feasible and effective in lowering temperature rapidly in a hospital emergency setting. This method of cooling offers the possibility for immediate introduction and needs now to be investigated in the field setting.

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Aims: To study the relationship between myocardial release of cTnI and myocardial cell death as assessed by the amount of apoptosis and necrosis after cardiac surgery. Methods: Eighteen young pigs were operated on with standardized cardiopulmonary bypass (CPB). Release of cTnI in the cardiac lymph (CL), coronary sinus (CS), and arterial blood (A) was related to postoperative myocardial cell death by both necrosis and apoptosis. Apoptotic cells were detected by a TUNEL detection kit. Necrotic cells were counted by light microscopy. Results: In all animals, cTnI was significantly released and reached peak values observed simultaneously in A (cTnI, 20.1±2.6 ng/ml) (mean ±SEM), CS (19.5±3.2 ng/ml) and CL (5202±2500 ng/ml). Percentage of total myocardial cell death was 3.1±0.5%, including 1.2±0.35% necrosis and 1.9±0.5% apoptosis. cTnI release during and after CPB did not correlate with the degree of myocardial apoptosis or necrosis. Conclusion: Cardiac operations with CPB are related to myocardial cell damage including myocardial cell death due to both necrosis and apoptosis. As the loss of cTnI is not related to the amount of cell death, our results suggest that increased cardiac myocyte membrane permeability more than cell death is responsible for intraoperative and postoperative cTnI release.