Use of an epidural cooling catheter with a closed countercurrent lumen to protect against ischemic spinal cord injury in pigs

Yoshitake, Akihiro; Mori, Atsuo; Shimizu, Hideyuki; Ueda, Toshihiko; Kabei, Nobuyuki; Hachiya, Takashi; Yozu, Ryohei

doi:10.1016/j.jtcvs.2007.06.015

Cited by 32 publications

(28 citation statements)

References 17 publications

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“…In 1986, Robertson et al showed that moderate hypothermia (338C) increased the duration of ischemia required to produce neurological deficits in rabbits (Robertson et al, 1986). Hypothermia has been found to improve outcome in several animal models of ischemic SCI, including pigs (Colon et al, 1987;Strauch et al, 2004), rabbits (Naslund et al, 1992;Wakamatsu et al, 1999;Tetik et al, 2002), and dogs (Berguer et al, 1992;Tabayashi et al, 1993) Various new methodologies producing local cooling including epidural cooling techniques have also provided positive results (Yoshitake et al, 2007). In a study by Malatova et al (1995), an epidural cooling technique provided evidence that deep spinal cord hypothermia provided some degree of protection following a regional ischemic insult.…”

Section: Spinal Cord Ischemiamentioning

confidence: 99%

Protection in Animal Models of Brain and Spinal Cord Injury with Mild to Moderate Hypothermia

Dietrich

Atkins

Bramlett

2009

Journal of Neurotrauma

133

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For the past 20 years, various laboratories throughout the world have shown that mild to moderate levels of hypothermia lead to neuroprotection and improved functional outcome in various models of brain and spinal cord injury (SCI). Although the potential neuroprotective effects of profound hypothermia during and following central nervous system (CNS) injury have long been recognized, more recent studies have described clinically feasible strategies for protecting the brain and spinal cord using hypothermia following a variety of CNS insults. In some cases, only a one or two degree decrease in brain or core temperature can be effective in protecting the CNS from injury. Alternatively, raising brain temperature only a couple of degrees above normothermia levels worsens outcome in a variety of injury models. Based on these data, resurgence has occurred in the potential use of therapeutic hypothermia in experimental and clinical settings. The study of therapeutic hypothermia is now an international area of investigation with scientists and clinicians from every part of the world contributing to this important, promising therapeutic intervention. This paper reviews the experimental data obtained in animal models of brain and SCI demonstrating the benefits of mild to moderate hypothermia. These studies have provided critical data for the translation of this therapy to the clinical arena. The mechanisms underlying the beneficial effects of mild hypothermia are also summarized.

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Section: Spinal Cord Ischemiamentioning

confidence: 99%

Protection in Animal Models of Brain and Spinal Cord Injury with Mild to Moderate Hypothermia

Dietrich

Atkins

Bramlett

2009

Journal of Neurotrauma

133

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“…In a group of studies using a closed hypothermic system in pigs, Mori et al 16 used a closed-loop catheter system to circulate iced saline in the epidural space to achieve subarachnoid cooling as low as 27.9°C. Yoshitake et al, 17 from the same institution as Mori et al, repeated a trial with that system in pigs to circulate hypothermic saline at 4°C, achieving subarachnoid temperatures as low as 20.8°C at L4, though both groups performed a partial laminectomy and ligamentum flavum removal to allow entry of their catheter system. In another study from that group, Ishikawa et al 18 showed decreased reactive hyperperfusion following aortic unclamping and postulated induction of nitric oxide synthase as a protective mechanism.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Hypothermia without Systemic Hypothermia

Purdy¹,

Novakovic²,

Giles³

et al. 2012

AJNR Am J Neuroradiol

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“…Epidural cooling also has some drawbacks, including a sharp rise in the CSF pressure and uncertain homogenous cooling of the spinal cord. Recently, as a solution for these adverse phenomena, a countercurrent closed-lumen epidural catheter was developed [79,80].…”

Section: Spinal Cord Protection During Aortic Surgerymentioning

confidence: 99%

Cardiovascular Surgical Technique Under Cardiopulmonary Bypass and Cerebrospinal Protection

Ogino

2015

Neuroanesthesia and Cerebrospinal Protection

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Brain and spinal cord injuries are some of the most troublesome sequelae during perioperative periods of cardiovascular surgery, which decrease the patient quality of life in the long term and can subsequently lead to serious morbidity and mortality. In cardiac surgery, one cause of perioperative cerebral complications is cardiopulmonary bypass (CPB). Off-pump coronary artery bypass grafting, particularly with a non-touch aortic technique, has been developed for preventing cerebral deficits. Other crucial issues are intraoperative examination of the ascending aorta with epiaortic echo and appropriate selection of alternative CPB cannulation sites such as the axillary or femoral arteries. On the other hand, in a variety of recently advanced endovascular aortic repair techniques, protection of the central nervous system is of greater concern, because the perfusion vessels of the brain, spinal cord, or both are involved in the surgical repairs. Hypothermia is still the underlying principle for cerebrospinal protection methods, because of the increased safety margin for preventing ischemic injury. Based on mild to moderate hypothermia, several kinds of antegrade and retrograde perfusion modalities are used for more secure protection. However, since they do not always provide complete cerebrospinal protection, several technical or pharmacological adjuncts should be added. These include precise preoperative examination of aortic and arterial lesions including identification of the Adamkiewicz artery, perioperative neuromonitoring with regional cerebral oxygenation and motor-evoked potentials, and various pharmacological methods.

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Use of an epidural cooling catheter with a closed countercurrent lumen to protect against ischemic spinal cord injury in pigs

Abstract: By cooling the spinal cord selectively and continuously, the newly designed epidural cooling catheter prevented ischemic injury in a pig model of aortic crossclamping.

Cited by 32 publications

References 17 publications

Protection in Animal Models of Brain and Spinal Cord Injury with Mild to Moderate Hypothermia

Protection in Animal Models of Brain and Spinal Cord Injury with Mild to Moderate Hypothermia

Spinal Cord Hypothermia without Systemic Hypothermia

Cardiovascular Surgical Technique Under Cardiopulmonary Bypass and Cerebrospinal Protection

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