Induced hypothermia in dogs with acute myocardial infarction and shock

Boyer, Norman H.; Gerstein, Mordecai M.

doi:10.1016/s0022-5223(19)41389-5

Cited by 27 publications

(11 citation statements)

References 28 publications

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“…The success of operative hypothermia led to the suggestion that hypothermia may be of benefit to patients with primary myocardial failure in the postoperative period. In addition to the possible beneficial metabolic effects, there was also evidence that moderate hypothermia may have a direct beneficial effect on myocardial function, particularly if there was pre‐existing ventricular dysfunction [4, 16–19]. There may also be some added direct beneficial effect on the failing myocardium secondary to the decrease in heart rate caused by the direct effect of cold on the sino‐atrial node [20].…”

Section: Discussionmentioning

confidence: 99%

Induced hypothermia in the postoperative management of refractory cardiac failure following paediatric cardiac surgery

Deakin¹,

Knight²,

Edwards³

et al. 1998

Anaesthesia

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Postoperative low cardiac output states are a major cause of postoperative mortality in infants and children following corrective cardiac surgery for congenital heart defects. In this unit, whole body hypothermia has been used since 1979 in the management of these low output states when they are refractory to conventional modes of therapy. Twenty cases treated in this way between July 1986 and June 1990 were reviewed in 1992. The current report reviews the 50 further cases treated with moderate hypothermia between July 1990 and December 1995. The median (range) age of patients was 8 months (0 days-16 years) with a median weight of 4.1 kg (2.5-33 kg). Following cooling, there was a decrease in heart rate (p < 0.001), an increase in mean arterial pressure (p < 0.001) and a decrease in mean atrial pressure (p < 0.001). Significant increases in pH and urine output were also noticed, the increase in urine output being greater in the surviving group (p = 0.02). A decrease in platelet count occurred (p < 0.001) but white blood cell count remained unchanged (p = 0.18). Twenty-five of the 50 patients survived to leave hospital. Induced hypothermia does not appear to be associated with any complications and after the failure of all conventional treatment, it seems likely that the technique may have been beneficial to outcome in some patients.

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Section: Discussionmentioning

confidence: 99%

Induced hypothermia in the postoperative management of refractory cardiac failure following paediatric cardiac surgery

Deakin¹,

Knight²,

Edwards³

et al. 1998

Anaesthesia

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“…Moreover, hypothermia is known to affect the cardiovascular (CV) system in multiple ways, many of which could prove advantageous in CS, especially after post-MI. In a study conducted in a dog model of acute post-MI CS, hypothermia maintained at 32°C was associated with a decrease in systemic oxygen consumption, heart rate, left ventricular end-diastolic pressure, as well as myocardial oxygen consumption, while stroke work/volume and cardiac output were maintained along with improved survival time 7. This latter study was recently validated in an ischaemic CS pig model in which acute mortality was also reduced in the therapeutic hypothermia group 8.…”

Section: Introductionmentioning

confidence: 90%

Protocol for a multicentre randomised controlled trial evaluating the effects of moderate hypothermia versus normothermia on mortality in patients with refractory cardiogenic shock rescued by venoarterial extracorporeal membrane oxygenation (VA-ECMO) (HYPO-ECMO study)

et al. 2019

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IntroductionVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to support the most severe forms of cardiogenic shock (CS). Nevertheless, despite extracorporeal membrane oxygenation (ECMO) use, mortality still remains high (50%). Moderate hypothermia (MH) (33°C–34°C) may improve cardiac performance and decrease ischaemia–reperfusion injuries. The use of MH during VA-ECMO is strongly supported by experimental and preliminary clinical data.Methods and analysisThe Hypothermia-Extracorporeal Membrane Oxygenation (HYPO-ECMO) study is a multicentre, prospective, controlled randomised trial between an MH group (33°C≤T°C≤34°C) and normothermia group (36°C≤T°C≤37°C). The primary endpoint is all-cause mortality at day 30 following randomisation. The study will also assess as secondary endpoints the effects of targeted temperature management strategies on (1) mortality rate at different time points, (2) organ failure and supportive treatment use and (3) safety. All intubated adults with refractory CS supported with VA-ECMO will be screened. Exclusion criteria are patients having undergone cardiac surgery for heart transplantation or left or biventricular assist device implantation, acute poisoning with cardiotoxic drugs, pregnancy, uncontrolled bleeding and refractory cardiac arrest.Three-hundred and thirty-four patients will be randomised and followed up to 6 months to detect a 15% difference in mortality. Data analysis will be intention to treat. The differences between the two study groups in the risk of all-cause mortality at day 30 following randomisation will be studied using logistic regression analysis adjusted for postcardiotomy setting, prior cardiac arrest, prior myocardial infarction, age, vasopressor dose, Sepsis-related Organ Failure Assessment (SOFA) score and lactate at randomisation.Ethics and disseminationEthics approval has been granted by the Comité de Protection des Personnes Est III Ethics Committee. The trial has been approved by the French Health Authorities (Agence Nationale de la Sécurité du Médicament et des Produits de Santé). Dissemination of results will be performed via journal articles and presentations at national and international conferences. Since this study is also the first step in the constitution of an ‘ECMO Trials Group’, its results will also be disseminated by the aforementioned group.Trial registration numberNCT 02754193.

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“…73 This improvement in perfusion increases oxygen delivery to cardiac tissue, where basal oxygen demand has already been reduced by the low temperatures. 72,74…”

Section: The Effects Of Therapeutic Cooling On the Heartmentioning

confidence: 99%

“…73 This improvement in perfusion increases oxygen delivery to cardiac tissue, where basal oxygen demand has already been reduced by the low temperatures. 72,74 Mixed venous oxygen saturation (SvO2) is a better indicator of organ perfusion than cardiac index (CI) during therapeutic hypothermia. 75 In hypothermic conditions a decrease in CI does not necessarily mean that organ perfusion is reduced as well.…”

Section: Cardiac Perfusionmentioning

confidence: 99%

Editor’s Choice- Inside the cold heart: A review of therapeutic hypothermia cardioprotection

Chavez

León

Einav

et al. 2016

European Heart Journal: Acute Cardiovascular Care

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Targeted temperature management has been originally used to reduce neurological injury and improve outcome in patients after out-of-hospital cardiac arrest. Myocardial infarction remains a major cause of death in the world and several investigators are studying the effect of mild therapeutic hypothermia during an acute cardiac ischemic injury. A search on MEDLINE, Scopus and EMBASE databases was conducted to obtain data regarding the cardioprotective properties of therapeutic hypothermia. Preclinical studies have shown that therapeutic hypothermia provides a cardioprotective effect in animals. The proposed pathways for the cardioprotective effects of therapeutic hypothermia include stabilization of mitochondrial permeability, production of nitric oxide, equilibration of reactive oxygen species, and calcium channels homeostasis. Clinical trials in humans have yielded controversial results. Current trials are therefore seeking to combine therapeutic hypothermia with other treatment modalities in order to improve the outcomes of patients with acute ischemic injury. This article provides a review of the hypothermia effects on the cardiovascular system, from the basic science of physiological changes in the human body and molecular mechanisms of cardioprotection to the bench of clinical trials with therapeutic hypothermia in patients with acute ischemic injury.

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Induced hypothermia in dogs with acute myocardial infarction and shock

Cited by 27 publications

References 28 publications

Induced hypothermia in the postoperative management of refractory cardiac failure following paediatric cardiac surgery

Induced hypothermia in the postoperative management of refractory cardiac failure following paediatric cardiac surgery

Protocol for a multicentre randomised controlled trial evaluating the effects of moderate hypothermia versus normothermia on mortality in patients with refractory cardiogenic shock rescued by venoarterial extracorporeal membrane oxygenation (VA-ECMO) (HYPO-ECMO study)

Editor’s Choice- Inside the cold heart: A review of therapeutic hypothermia cardioprotection

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