Hypoxic-ischaemic brain injury (HIBI) after cardiopulmonary arrest

A comparison between head cooling begun during cardiopulmonary resuscitation and surface cooling after resuscitation in a pig model of cardiac arrest

OBJECTIVE

Employing transnasal head-cooling in a pig model of prolonged ventricular fibrillation, we compared the effects of 4 hrs of head-cooling started during cardiopulmonary resuscitation with those of 8 hrs of surface-cooling started at 2 hrs after resuscitation on 96-hr survival and neurologic outcomes.

DESIGN

Prospective controlled animal study.

SETTING

University-affiliated research laboratory.

SUBJECTS

Domestic pigs.

INTERVENTIONS

Twenty-four male pigs were subjected to 10 min of untreated ventricular fibrillation followed by 5 min of cardiopulmonary resuscitation. In the head-cooling group, hypothermia was started with cardiopulmonary resuscitation and continued for 4 hrs after resuscitation. In the surface-cooling group, systemic hypothermia with a cooling blanket was started, in accord with current clinical practices, at 2 hrs after resuscitation and continued for 8 hrs. Methods in the control animal studies were identical except for temperature interventions.

MEASUREMENTS AND MAIN RESULTS

All animals were resuscitated except for one animal in each of the surface-cooling and control groups. After 5 min of cardiopulmonary resuscitation, jugular vein temperature was significantly decreased in the head-cooled animals. However, there were no differences in pulmonary artery temperatures among the three groups at that time. Nevertheless, both head-cooled and surface-cooled animals had an improved 96-hr survival after resuscitation. Significantly better neurologic outcomes were observed in early head-cooled animals in the first 3 days after resuscitation.

CONCLUSION

Early head-cooling during cardiopulmonary resuscitation continuing for 4 hrs after resuscitation produced favorable survival and neurologic outcomes in comparison with delayed surface-cooling of 8 hrs duration.