Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function?

Abstract

BackgroundExtracorporeal cardiopulmonary resuscitation (E-CPR) is increasingly used as a rescue method in the management of cardiac arrest and provides the opportunity to rapidly induce therapeutic hypothermia. The survival after a cardiac arrest is related to post-arrest cardiac function, and the application of therapeutic hypothermia post-arrest is hypothesized to improve cardiac outcome. The present animal study compares normothermic and hypothermic E-CPR considering resuscitation success, post-arrest left ventricular function and magnitude of myocardial injury.MethodsAfter a 15-min untreated ventricular fibrillation, the pigs (n = 20) were randomized to either normothermic (38 °C) or hypothermic (32–33 °C) E-CPR. Defibrillation terminated ventricular fibrillation after 5 min of E-CPR, and extracorporeal support continued for 2 h, followed by warming, weaning and a stabilization period. Magnetic resonance imaging and left ventricle pressure measurements were used to assess left ventricular function pre-arrest and 5 h post-arrest. Myocardial injury was estimated by serum concentrations of cardiac TroponinT and Aspartate transaminase (ASAT).ResultsE-CPR resuscitated all animals and the hypothermic strategy induced therapeutic hypothermia within minutes without impairment of the resuscitation success rate. All animals suffered a severe global systolic left ventricular dysfunction post-arrest with 50–70% reductions in stroke volume, ejection fraction, wall thickening, strain and mitral annular plane systolic excursion. Serum concentrations of cardiac TroponinT and ASAT increased considerably post-arrest. No significant differences were found between the two groups.ConclusionsTwo-hour therapeutic hypothermia during E-CPR offers an equal resuscitation success rate, but does not preserve the post-arrest cardiac function nor reduce the magnitude of myocardial injury, compared to normothermic E-CPR. Trial registration FOTS 4611/13 registered 25 October 2012Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-016-1099-y) contains supplementary material, which is available to authorized users.

Deep ocean water has significant physiological effects on squid Todarodes pacificus

“…Those reared with DOW had a reduced weight loss by suppressing liver metabolism. On the other hand, their hemolymph AST and CK levels, which are markers of cardiac and skeletal muscle [10,12,13,14], did not signi cantly decrease, possibly because they were constantly moving their muscles to swim.…”

Extracorporeal cardiopulmonary resuscitation with temperature management could improve the neurological outcomes of out-of-hospital cardiac arrest: a retrospective analysis of a nationwide multicenter observational study in Japan

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The use of induced hypothermia in extracorporeal membrane oxygenation: A narrative review

“…Moreover, with the exception of one experiment realized in the setting of CS, 40 all other studies were conducted in CA models. 33 , 34 , 35 , 36 , 37 , 38 , 39 …”