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Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function?
BACKGROUND: Extracorporeal 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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175383/ https://www.ncbi.nlm.nih.gov/pubmed/27998282 http://dx.doi.org/10.1186/s12967-016-1099-y |
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author | Bergan, Harald A. Halvorsen, Per S. Skulstad, Helge Fosse, Erik Bugge, Jan F. |
author_facet | Bergan, Harald A. Halvorsen, Per S. Skulstad, Helge Fosse, Erik Bugge, Jan F. |
author_sort | Bergan, Harald A. |
collection | PubMed |
description | BACKGROUND: Extracorporeal 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. METHODS: After 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). RESULTS: E-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. CONCLUSIONS: Two-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 2012 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12967-016-1099-y) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5175383 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-51753832016-12-28 Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? Bergan, Harald A. Halvorsen, Per S. Skulstad, Helge Fosse, Erik Bugge, Jan F. J Transl Med Research BACKGROUND: Extracorporeal 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. METHODS: After 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). RESULTS: E-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. CONCLUSIONS: Two-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 2012 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12967-016-1099-y) contains supplementary material, which is available to authorized users. BioMed Central 2016-12-20 /pmc/articles/PMC5175383/ /pubmed/27998282 http://dx.doi.org/10.1186/s12967-016-1099-y Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Bergan, Harald A. Halvorsen, Per S. Skulstad, Helge Fosse, Erik Bugge, Jan F. Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? |
title | Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? |
title_full | Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? |
title_fullStr | Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? |
title_full_unstemmed | Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? |
title_short | Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? |
title_sort | does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175383/ https://www.ncbi.nlm.nih.gov/pubmed/27998282 http://dx.doi.org/10.1186/s12967-016-1099-y |
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