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Wang X, Wehbe A, Kaura S, Chaudhry N, Geng X, Ding Y. Updates on Selective Brain Hypothermia: Studies From Bench Work to Clinical Trials. Front Neurol 2022; 13:899547. [PMID: 35599727 PMCID: PMC9120368 DOI: 10.3389/fneur.2022.899547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/13/2022] [Indexed: 12/01/2022] Open
Abstract
Thrombectomy or thrombolysis are the current standards of care for acute ischemic stroke (AIS), however, due to time constraints regarding operations and a multitude of contraindications, AIS remains one of the leading causes of death and chronic disability worldwide. In recent years, therapeutic hypothermia has been explored as an adjuvant therapy for AIS treatment and has shown potential to improve outcomes in patients with AIS. In particular, selective therapeutic hypothermia has shown to markedly reduce infarct volumes and have neuroprotective effects, while also minimizing many systemic side effects seen with systemic therapeutic hypothermia. Both preclinical and clinical trials have demonstrated that selective therapeutic hypothermia is a safe and feasible therapy for patients who have suffered an AIS. In this review, we summarize the current update on selective hypothermia through major studies that have been conducted in rodents, large animals, and clinical trials, and briefly discuss the prospects of selective hypothermic research. We hope this review helps facilitate the exploration of other possible adjuvant treatment modalities in the neuroprotection of ischemic stroke, whether upon symptom onset or after vascular recanalization.
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Affiliation(s)
- Xiaoyu Wang
- Department of Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Alexandra Wehbe
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Shawn Kaura
- Lake Erie College of Osteopathic Medicine at Seton Hill, Greensburg, PA, United States
| | - Naveed Chaudhry
- Lake Erie College of Osteopathic Medicine at Seton Hill, Greensburg, PA, United States
| | - Xiaokun Geng
- Department of Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
- *Correspondence: Xiaokun Geng
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
- Yuchuan Ding
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Feasibility and Safety of Transnasal High Flow Air to Reduce Core Body Temperature in Febrile Neurocritical Care Patients: A Pilot Study. Neurocrit Care 2020; 31:280-287. [PMID: 30919302 DOI: 10.1007/s12028-019-00702-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Fever is an important determinant of prognosis following acute brain injury. Current non-pharmacologic techniques to reduce fever are limited and induce a shivering response. We investigated the safety and efficacy of a novel transnasal unidirectional high flow air device in reducing core body temperature in the neurocritical care unit (NCCU) setting. METHODS This pilot study included seven consecutive patients in the NCCU who were febrile (> 37.5 °C) for > 24 h despite standard non-pharmacologic and first-line antipyretic agents. Medical grade high flow air was delivered transnasally using a standard continuous positive airway pressure machine with a positive pressure of 20 cmH2O for 2 h. Core esophageal and tympanic temperature were continuously monitored. RESULTS Mean age was 40 ± 14 yo, and 72% (5/7 patients) were men. Five patients had intracerebral or intraventricular hemorrhage, one subject had transverse myelitis, and the remaining patient had anoxic brain injury due to a cardiac arrest. After 2 h of cooling, core temperature was significantly lower than the baseline pre-cooling temperature (37.3 ± 0.5 °C vs. 38.4 ± 0.6 °C; p < 0.002). Mean transnasal airflow rate was 57.5 ± 6.5 liters per minute. Five of the seven subjects were normothermic at the end of the 2-h period. One subject with severe hyperthermia (39.7 °C) and the other with multiple interruptions to therapy due to technical reasons did not cool. The core temperature within 30 min of cessation of airflow increased and was similar to the pre-cooling baseline temperature (38.3 ± 0.4 °C vs. 38.4 ± 0.6 °C, p = NS). Rate of core cooling was 0.6 ± 0.15 °C per hour at this flow rate. No shivering response was observed. No protocol-related adverse events occurred. CONCLUSIONS High flow transnasal air in a unidirectional fashion lowers core body temperature in febrile patients in the NCCU setting. No adverse events were seen, and the process showed no signs of shivering or any other serious side effects during short-term exposure. This pilot study should inform further investigation.
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Assis FR, Ambadipudi S, Bhambhani H, Shah R, Daimee UA, Tandri H. Effects of High-Flow Transesophageal Dry Air on Core Temperature: A Novel Method of Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2020; 11:88-95. [PMID: 32326838 DOI: 10.1089/ther.2019.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Therapeutic hypothermia (TH) is one of the few proven neuroprotective modalities in clinical practice. However, current methods to achieve TH are suboptimal. We investigated a novel esophageal device that utilizes high-flow transesophageal dry air to achieve TH via evaporating cooling. Seven Yorkshire pigs (n = 7) underwent hypothermia therapy using a novel esophageal device that compartmentalizes a segment of esophagus through which high-flow dry air freely circulates in and out of the esophagus. Efficacy (primary objective) and safety (secondary objective) were evaluated in all animals. Safety assessment was divided into two sequential phases: (1) acute safety assessment (n = 5; terminal studies) to evaluate adverse events occurring during therapy, and (2) chronic safety assessment (n = 2; survival studies) to evaluate adverse events associated with therapy within 1 week of follow-up. After 1 hour of esophageal cooling (mean airflow rate = 64.2 ± 3.5 L/min), a significant reduction in rectal temperature was observed (37.3 ± 0.2°C → 36.3 ± 0.4°C, p = 0.002). The mean rectal temperature reduction was 1 ± 0.4°C. In none of the seven animals was oral or pharyngeal mucosa injury identified at postprocedural visual examination. In the two animals that survived, no reduction of food ingestion, signs of swallowing dysfunction or discomfort, or evidence of gastrointestinal bleeding was observed during the 1-week follow-up period. Open-chest visual inspection in those two animals did not show damage to the esophageal mucosa or surrounding structures. A novel esophageal device, utilizing high-flow transesophageal dry air, was able to efficiently induce hypothermia despite external heating. Therapy was well-tolerated, and no acute or chronic complications were found.
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Affiliation(s)
- Fabrizio R Assis
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sravya Ambadipudi
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hrithika Bhambhani
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rushil Shah
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Usama A Daimee
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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de Paiva BLC, Bor-Seng-Shu E, Silva E, Barreto ÍBM, de Lima Oliveira M, Ferreira RES, Cavalcanti AB, Teixeira MJ. Inducing Brain Cooling Without Core Temperature Reduction in Pigs Using a Novel Nasopharyngeal Method: An Effectiveness and Safety Study. Neurocrit Care 2020; 32:564-574. [PMID: 31317319 PMCID: PMC7223440 DOI: 10.1007/s12028-019-00789-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acute brain lesions constitute an alarming public health concern. Neuroprotective therapies have been implemented to stabilize, prevent, or reduce brain lesions, thus improving neurological outcomes and survival rates. Hypothermia is the most effective approach, mainly attributed to the reduction in cellular metabolic activity. Whole-body cooling is currently implemented by healthcare professionals; however, adverse events are frequent, limiting the potential benefits of therapeutic hypothermia. Therefore, selective methods have been developed to reduce adverse events while delivering neuroprotection. Nasopharyngeal approaches are the safest and most effective methods currently considered. Our primary objective was to determine the effects of a novel nasopharyngeal catheter on the brain temperature of pigs. METHODS In this prospective, non-randomized, interventional experimental trial, 10 crossbred pigs underwent nasopharyngeal cooling for 60 min followed by 15 min of rewarming. Nasopharyngeal catheters were inserted into the left nostril and properly positioned at the nasopharyngeal cavity. RESULTS Nasopharyngeal cooling was associated with a decrease in brain temperature, which was more significant in the left cerebral hemisphere (p = 0.01). There was a reduction of 1.47 ± 0.86 °C in the first 5 min (p < 0.001), 2.45 ± 1.03 °C within 10 min (p < 0.001), and 4.45 ± 1.36 °C after 1 h (p < 0.001). The brain-core gradient was 4.57 ± 0.87 °C (p < 0.001). Rectal, esophageal, and pulmonary artery temperatures and brain and systemic hemodynamic parameters, remained stable during the procedure. Following brain cooling, values of oxygen partial pressure in brain tissue significantly decreased. No mucosal lesions were detected during nasal, pharyngeal, or oral inspection after nasopharyngeal catheter removal. CONCLUSIONS In this study, a novel nasopharyngeal cooling catheter effectively induced and maintained exclusive brain cooling when combined with effective counter-warming methods. Exclusive brain cooling was safe with no device-related local or systemic complications and may be desired in selected patient populations.
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Affiliation(s)
- Bernardo Lembo Conde de Paiva
- Neurology Department, School of Medicine, University of São Paulo, Avenida Moema, 170, Cj. 83 - Moema, São Paulo, SP, CEP: 04077-020, Brazil.
- Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil.
| | - Edson Bor-Seng-Shu
- Neurology Department, School of Medicine, University of São Paulo, Avenida Moema, 170, Cj. 83 - Moema, São Paulo, SP, CEP: 04077-020, Brazil
- Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil
| | - Eliezer Silva
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Marcelo de Lima Oliveira
- Neurology Department, School of Medicine, University of São Paulo, Avenida Moema, 170, Cj. 83 - Moema, São Paulo, SP, CEP: 04077-020, Brazil
- Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil
| | - Raphael Einsfeld Simões Ferreira
- Neurocritical Care Unit, Hospital Santa Paula, São Paulo, SP, Brazil
- Research Centre, Centro Universitário São Camilo, São Paulo, SP, Brazil
| | | | - Manoel Jacobsen Teixeira
- Neurology Department, School of Medicine, University of São Paulo, Avenida Moema, 170, Cj. 83 - Moema, São Paulo, SP, CEP: 04077-020, Brazil
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Chen Y, Quddusi A, Harrison KA, Ryan PE, Cook DJ. Selection of preclinical models to evaluate intranasal brain cooling for acute ischemic stroke. Brain Circ 2019; 5:160-168. [PMID: 31950091 PMCID: PMC6950506 DOI: 10.4103/bc.bc_20_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/28/2019] [Indexed: 01/12/2023] Open
Abstract
Stroke accounts for a large proportion of global mortality and morbidity. Selective hypothermia, via intranasal cooling devices, is a promising intervention in acute ischemic stroke. However, prior to large clinical trials, preclinical studies in large animal models of ischemic stroke are needed to assess the efficacy, safety, and feasibility of intranasal cooling for selective hypothermia as a neuroprotective strategy. Here, we review the available scientific literature for evidence supporting selective hypothermia and make recommendations of a preclinical, large, animal-based, ischemic stroke model that has the greatest potential for evaluating intranasal cooling for selective hypothermia and neuroprotection. We conclude that among large animal models of focal ischemic stroke including pigs, sheep, dogs, and nonhuman primates (NHPs), cynomolgus macaques have nasal anatomy, nasal vasculature, neuroanatomy, and cerebrovasculature that are most similar to those of humans. Moreover, middle cerebral artery stroke in cynomolgus macaques produces functional and behavioral deficits that are quantifiable to a greater degree of precision and detail than those that can be revealed through available assessments for other large animals. These NHPs are also amenable to extensive neuroimaging studies as a means of monitoring stroke evolution and evaluating infarct size. Hence, we suggest that cynomolgus macaques are best suited to assess the safety and efficacy of intranasal selective hypothermia through an evaluation of hyperacute diffusion-weighted imaging and subsequent investigation of chronic functional recovery, prior to randomized clinical trials in humans.
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Affiliation(s)
- Yining Chen
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Ayesha Quddusi
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | | | - Paige E Ryan
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Surgery, Division of Neurosurgery, Kingston General Hospital, Kingston, ON, Canada
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Assis FR, Narasimhan B, Ziai W, Tandri H. From systemic to selective brain cooling - Methods in review. Brain Circ 2019; 5:179-186. [PMID: 31950093 PMCID: PMC6950511 DOI: 10.4103/bc.bc_23_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 01/14/2023] Open
Abstract
Therapeutic hypothermia (TH) remains one of the few proven neuroprotective modalities available in clinical practice today. Although targeting lower temperatures during TH seems to benefit ischemic brain cells, systemic side effects associated with global hypothermia limit its clinical applicability. Therefore, the ability to selectively reduce the temperature of the brain while minimally impacting core temperature allows for maximizing neurological benefit over systemic complications. In that scenario, selective brain cooling (SBC) has emerged as a promising modality of TH. In this report, we reviewed the general concepts of TH, from systemic to selective brain hypothermia, and explored the different cooling strategies and respective evidence, including preclinical and clinical data. SBC has been investigated in different animal models with promising results, wherein organ-specific, rapid, and deep target brain temperature managements stand out as major advantages over systemic TH. Nevertheless, procedure-related complications and adverse events still remain a concern, limiting clinical translation. Different invasive and noninvasive methods for SBC have been clinically investigated with variable results, and although adverse effects were still reported in some studies, therapies rendered overall safe profiles. Further study is needed to define the optimal technique, timing of initiation, rate and length of cooling as well as target temperature and rewarming protocols for different indications.
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Affiliation(s)
- Fabrizio R Assis
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharat Narasimhan
- Department of Internal Medicine, Mount Sinai St. Lukes-Roosevelt, New York, NY, USA
| | - Wendy Ziai
- Division of Anesthesia and Neurocritical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harikrishna Tandri
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Chava R, Zviman M, Assis FR, Raghavan MS, Halperin H, Maqbool F, Geocadin R, Quinones-Hinojosa A, Kolandaivelu A, Rosen BA, Tandri H. Effect of high flow transnasal dry air on core body temperature in intubated human subjects. Resuscitation 2018; 134:49-54. [PMID: 30359664 DOI: 10.1016/j.resuscitation.2018.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE Early initiation of hypothermia is recommended in the setting of cardiac arrest. Current hypothermia methods are invasive and expensive and not applicable in ambulatory settings. We investigated the evaporative cooling effect of high flow transnasal dry air on core esophageal temperature in human volunteers. METHODS & RESULTS A total of 32 subjects (mean age 53.2 ± 9.3 yrs., mean weight 90 ± 17 kg) presenting for elective electrophysiological procedures were enrolled for the study. Half of the subjects were men. Following general anesthesia induction, high flow (30 LPM) medical grade ambient dry air with a relative humidity ∼20% was administered through a nasal mask for 60 min. Core temperature was monitored at the distal esophagus. Half of the subjects (16/32) were subject to high flow air and the remainder served as controls. Over a 1-h period, mean esophageal temperature decreased from 36.1 ± 0.3 °C to 35.5 ± 0.1 °C in the test subjects (p < 0.05). No significant change in temperature was observed in the control subjects (36.3 ± 0.3 °C to 36.2 ± 0.2 °C, p = NS). No adverse events occurred. CONCLUSION Transnasal high flow dry air through the nasopharynx reduces core body temperature. This mechanism can be harnessed to induce hypothermia in patients where clinically indicated without any deleteriouseffects in a short time exposure.
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Affiliation(s)
- Raghuram Chava
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Menekhem Zviman
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fabrizio R Assis
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Henry Halperin
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Farhan Maqbool
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Romergryko Geocadin
- Department of Neuroanesthesia and Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alfredo Quinones-Hinojosa
- Department of Neuroanesthesia and Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aravindan Kolandaivelu
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benjamin A Rosen
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harikrishna Tandri
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Neuroprotective Effects of Nasopharyngeal Perfluorochemical Cooling in a Rat Model of Subarachnoid Hemorrhage. World Neurosurg 2018; 121:e481-e492. [PMID: 30267945 DOI: 10.1016/j.wneu.2018.09.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Subarachnoid hemorrhage (SAH) frequently results in severe morbidity, even mortality. Hypothermia is known to have a neuroprotective effect in ischemic injuries. The aim of this study was to determine whether nasopharyngeal (NP) perfluorochemical (PFC) cooling could be used in a rat model of SAH model for neuroprotection. METHODS SAH was induced in 16 male Sprague-Dawley rats by cisterna magna injection of 0.3 mL autologous blood. Vital signs, temperatures, cerebral blood flow (CBF), and brain histology were assessed. Brain cooling was performed on the treatment group using the NP-PFC method starting from 20 minutes after SAH. RESULTS No SAH-related deaths were observed in either group. SAH caused an immediate decrease in mean arterial pressure (17.0% ± 4.90% below baseline values). SAH induction caused a significant and rapid decrease in CBF from baseline (approximately -65%, ranging from -32% to -85%) in both hemispheres. In the left hemisphere, cooling facilitated the return of CBF to baseline values within 20 minutes of treatment with further increase in CBF that stabilized by the 2 hours after injury time point. Quantitative immunohistochemistry showed that there were significantly more NeuN-positive cells in the cortex and significantly fewer IBA-1-positive microglia and glial fibrillary acidic protein-positive astrocytes cells in both cortex and hippocampus in the animals that received NP-PFC cooling compared with no treatment, reflecting preserved neuronal integrity and reduced inflammation. CONCLUSIONS The data from this study indicate that local hypothermia by NP-PFC cooling supports return of CBF and neuronal integrity and suppresses the inflammatory response in SAH, suggestive of a promising neuroprotective approach in management of SAH.
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Lillicrap T, Tahtalı M, Neely A, Wang X, Bivard A, Lueck C. A model based on the Pennes bioheat transfer equation is valid in normal brain tissue but not brain tissue suffering focal ischaemia. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2017; 40:841-850. [PMID: 29098600 DOI: 10.1007/s13246-017-0595-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 10/18/2017] [Indexed: 11/29/2022]
Abstract
Ischaemic stroke is a major public health issue in both developed and developing nations. Hypothermia is believed to be neuroprotective in cerebral ischaemia. Conversely, elevated brain temperature is associated with poor outcome after ischaemic stroke. Mechanisms of heat exchange in normally-perfused brain are relatively well understood, but these mechanisms have not been studied as extensively during focal cerebral ischaemia. A finite element model (FEM) of heat exchange during focal ischaemia in the human brain was developed, based on the Pennes bioheat equation. This model incorporated healthy (normally-perfused) brain tissue, tissue that was mildly hypoperfused but not at risk of cell death (referred to as oligaemia), tissue that was hypoperfused and at risk of death but not dead (referred to as penumbra) and tissue that had died as a result of ischaemia (referred to as infarct core). The results of simulations using this model were found to match previous in-vivo temperature data for normally-perfused brain. However, the results did not match what limited data are available for hypoperfused brain tissue, in particular the penumbra, which is the focus of acute neuroprotective treatments such as hypothermia. These results suggest that the assumptions of the Pennes bioheat equation, while valid in the brain under normal circumstances, are not valid during focal ischaemia. Further investigation into the heat exchange profiles that do occur during focal ischaemia may yield results for clinical trials of therapeutic hypothermia.
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Affiliation(s)
| | - Murat Tahtalı
- School of Engineering and IT, UNSW Canberra, Canberra, Australia
| | - Andrew Neely
- School of Engineering and IT, UNSW Canberra, Canberra, Australia
| | - Xiaofei Wang
- National University of Singapore, Singapore, Singapore
| | - Andrew Bivard
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Christian Lueck
- Medical School, Australian National University, Canberra, Australia.,Neurology Department, The Canberra Hospital, Canberra, Australia
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Abstract
BACKGROUND Mild hypothermia is an effective neuroprotective strategy for a variety of acute brain injuries. Cooling the nasopharynx may offer the capability to cool the brain selectively due to anatomic proximity of the internal carotid artery to the cavernous sinus. This study investigated the feasibility and efficiency of nasopharyngeal brain cooling by continuously blowing room temperature or cold air at different flow rates into the nostrils of normal newborn piglets. METHODS Experiments were conducted on thirty piglets (n = 30, weight = 2.7 ± 1.5 kg). Piglets were anesthetized with 1–2% isoflurane and were randomized to receive one of four different nasopharyngeal cooling treatments: I. Room temperature at a flow rate of 3–4 L min(−1) (n = 6); II. −1 ± 2 °C at a flow rate of 3–4 L min(−1) (n = 6); III. Room temperature at a flow rate of 14–15 L min(−1) (n = 6); IV. −8 ± 2 °C at a flow rate of 14–15 L min(−1) (n = 6). To control for the normal thermal regulatory response of piglets without nasopharyngeal cooling, a control group of piglets (n = 6) had their brain temperature monitored without nasopharyngeal cooling. The duration of treatment was 60 min, with additional 30 min of observation. RESULTS In group I, median cooling rate was 1.7 ± 0.9 °C/h by setting the flow rate of room temperature air to 3–4 L min(−1). Results of comparing different temperatures and flow rates in the nasopharyngeal cooling approach reveal that the brain temperature could be reduced rapidly at a rate of 5.5 ± 1.1 °C/h by blowing −8 ± 2 °C air at a flow rate of 14–15 L min(−1). CONCLUSIONS Nasopharyngeal cooling via cooled insufflated air can lower the brain temperature, with higher flows and lower temperatures of insufflated air being more effective.
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Fazel Bakhsheshi M, Wang Y, Keenliside L, Lee TY. A new approach to selective brain cooling by a Ranque-Hilsch vortex tube. Intensive Care Med Exp 2016; 4:32. [PMID: 27686339 PMCID: PMC5042908 DOI: 10.1186/s40635-016-0102-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 09/08/2016] [Indexed: 11/29/2022] Open
Abstract
Background Target temperature management is the single most effective intervention and the gold standard in post-resuscitation care today. However, cooling the whole body below 33–34 °C can cause severe complications. Therefore, developing a selective brain cooling (SBC) approach which can be initiated early to induce rapid cooling and maintain the target temperature over 12–24 h before slowly rewarming brain temperature by itself alone would be advantageous. Vortex tubes are simple mechanical devices generating cold air from a stream of compressed air without applied chemical or energy. This study investigated whether blowing cooled air from a vortex tube into the nasal cavities is safe and effective to selectively reduce and maintain before slowly rewarming brain temperature back to normal temperature. Methods Experiments were conducted on ten juvenile pigs. Body temperature was measured using an esophageal and a rectal temperature probe while brain temperature with an intraparenchymal thermocouple probe. Cerebral blood flow (CBF) was measured with CT perfusion. Results Brain temperature dropped below 34 °C within 30–40 min while a brain-esophageal temperature difference greater than 3 °C was maintained over 6 h. There was no evidence of nasal or nasopharynx mucosal swelling, necrosis, or hemorrhage on MRI examination. CBF first decreased and then stabilized together with brain temperature before increasing to the baseline level during rewarming. Conclusions SBC was accomplished by blowing cold air from a vortex tube into the nasal cavities. Due to its portability, the method can be used continuously in resuscitated patients in both in- and out-of-hospital situations without interruption.
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Affiliation(s)
- Mohammad Fazel Bakhsheshi
- Imaging Program, Lawson Health Research Institute, London, ON, Canada. .,Imaging Research Laboratories, Robarts Research Institute, 1151 Richmond Street North, London, ON, N6A 5B7, Canada.
| | - Yong Wang
- Imaging Program, Lawson Health Research Institute, London, ON, Canada.,Imaging Research Laboratories, Robarts Research Institute, 1151 Richmond Street North, London, ON, N6A 5B7, Canada
| | - Lynn Keenliside
- Imaging Program, Lawson Health Research Institute, London, ON, Canada.,Imaging Research Laboratories, Robarts Research Institute, 1151 Richmond Street North, London, ON, N6A 5B7, Canada
| | - Ting-Yim Lee
- Imaging Program, Lawson Health Research Institute, London, ON, Canada.,Imaging Research Laboratories, Robarts Research Institute, 1151 Richmond Street North, London, ON, N6A 5B7, Canada.,Department of Medical Imaging and Biophysics, The University of Western Ontario, London, ON, Canada
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Chava R, Zviman M, Raghavan MS, Halperin H, Maqbool F, Geocadin R, Quinones-Hinojosa A, Kolandaivelu A, Rosen BA, Tandri H. Rapid Induction of Therapeutic Hypothermia Using Transnasal High Flow Dry Air. Ther Hypothermia Temp Manag 2016; 7:50-56. [PMID: 27635468 DOI: 10.1089/ther.2016.0016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Early induction of therapeutic hypothermia (TH) is recommended in out-of-hospital cardiac arrest (CA); however, currently no reliable methods exist to initiate cooling. We investigated the effect of high flow transnasal dry air on brain and body temperatures in adult porcine animals. Adult porcine animals (n = 23) under general anesthesia were subject to high flow of transnasal dry air. Mouth was kept open to create a unidirectional airflow, in through the nostrils and out through the mouth. Brain, internal jugular, and aortic temperatures were recorded. The effect of varying airflow rate and the air humidity (0% or 100%) on the temperature profiles were recorded. The degree of brain cooling was measured as the differential temperature from baseline. A 10-minute exposure of high flow dry air caused rapid cooling of brain and gradual cooling of the jugular and the aortic temperatures in all animals. The degree of brain cooling was flow dependent and significantly higher at higher airflow rates (0.8°C ± 0.3°C, 1.03°C ± 0.6°C, and 1.3°C ± 0.7°C for 20, 40, and 80 L, respectively, p < 0.05 for all comparisons). Air temperature had minimal effect on the brain cooling over 10 minutes with similar decrease in temperature at 4°C and 30°C. At a constant flow rate (40 LPM) and temperature, the degree of cooling over 10 minutes during dry air exposure was significantly higher compared to humid air (100% saturation) (1.22°C ± 0.35°C vs. 0.21°C ± 0.12°C, p < 0.001). High flow transnasal dry air causes flow dependent cooling of the brain and the core temperatures in intubated porcine animals. The mechanism of cooling appears to be evaporation of nasal mucus as cooling is mitigated by humidifying the air. This mechanism may be exploited to initiate TH in CA.
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Affiliation(s)
- Raghuram Chava
- Division of Cardiology, Departments of Neuroanesthesia and Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Menekhem Zviman
- Division of Cardiology, Departments of Neuroanesthesia and Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Madhavan Srinivas Raghavan
- Division of Cardiology, Departments of Neuroanesthesia and Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Henry Halperin
- Division of Cardiology, Departments of Neuroanesthesia and Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Farhan Maqbool
- Division of Cardiology, Departments of Neuroanesthesia and Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Romergryko Geocadin
- Division of Cardiology, Departments of Neuroanesthesia and Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Alfredo Quinones-Hinojosa
- Division of Cardiology, Departments of Neuroanesthesia and Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Aravindan Kolandaivelu
- Division of Cardiology, Departments of Neuroanesthesia and Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Benjamin A Rosen
- Division of Cardiology, Departments of Neuroanesthesia and Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Harikrishna Tandri
- Division of Cardiology, Departments of Neuroanesthesia and Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
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Kohlhauer M, Berdeaux A, Kerber RE, Micheau P, Ghaleh B, Tissier R. Liquid Ventilation for the Induction of Ultrafast Hypothermia in Resuscitation Sciences: A Review. Ther Hypothermia Temp Manag 2016; 6:63-70. [DOI: 10.1089/ther.2015.0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthias Kohlhauer
- Inserm, Unité 955, Equipe 03, Créteil, France
- Université Paris Est, UMR_S955, DHU A-TVB, UPEC, Créteil, France
- Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France
| | - Alain Berdeaux
- Inserm, Unité 955, Equipe 03, Créteil, France
- Université Paris Est, UMR_S955, DHU A-TVB, UPEC, Créteil, France
- Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France
| | - Richard E. Kerber
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Philippe Micheau
- Department of Mechanical Engineering, Université de Sherbrooke, Sherbrooke, Canada
| | - Bijan Ghaleh
- Inserm, Unité 955, Equipe 03, Créteil, France
- Université Paris Est, UMR_S955, DHU A-TVB, UPEC, Créteil, France
- Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France
| | - Renaud Tissier
- Inserm, Unité 955, Equipe 03, Créteil, France
- Université Paris Est, UMR_S955, DHU A-TVB, UPEC, Créteil, France
- Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France
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Lampe JW, Bratinov G, Weiland TR, Illindala U, Berg RA, Becker LB. Volume infusion cooling increases end-tidal carbon dioxide and results in faster and deeper cooling during intra-cardiopulmonary resuscitation hypothermia induction. Intensive Care Med Exp 2015; 3:37. [PMID: 26715581 PMCID: PMC4695470 DOI: 10.1186/s40635-015-0073-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/20/2015] [Indexed: 11/22/2022] Open
Abstract
Background Intra-arrest hypothermia induction may provide more benefit than inducing hypothermia after return of spontaneous circulation. However, little is understood about the interaction between patient physiology and hypothermia induction technology choice during ongoing chest compressions. Methods After 10 min of untreated ventricular fibrillation, mechanical chest compressions were provided for 60 min (100 CPM, 1.25" deep) in 26 domestic swine (30.5 ± 1.7 kg) with concurrent hypothermia induction using one of eight cooling methods. Four cooling methods included volume infusion with cold saline or an ice particulate slurry through the femoral vein or carotid artery (volume infusion cooling group, VC); three included cooling via an intra-vascular heat exchange catheter, nasal cooling, or surface ice bags (no volume cooling group, NVC); and the other was a control group with no cooling (no cooling group, NC). Physiological monitoring included end-tidal carbon dioxide, aortic pressure, right atrial pressure, brain temperature, esophageal temperature, and rectal temperature. Results During cardiopulmonary resuscitation (CPR), the volume infusion cooling group cooled faster and to lower temperatures than the other groups (VC vs. NVC or NC; ∆T = −5.6 vs. −2.1 °C or −0.6 °C; p < 0.01). The aortic pressure and right atrial pressure were higher in the volume cooling group than the other groups (VC vs. NVC or NC; AOP = 23.6 vs. 16.7 mmHg or 14.7 mmHg; p < 0.02). End-tidal carbon dioxide measurements during CPR were also higher in the volume cooling group (VC vs. NVC; EtCO2 = 23.4 vs. 13.1 mmHg; p < 0.05). Intra-corporeal temperature gradients larger than 3 °C were created by volume cooling during ongoing chest compressions. Conclusions Volume infusion cooling significantly altered physiology relative to other cooling methods during ongoing chest compressions. Volume cooling led to faster cooling rates, lower temperatures, higher end-tidal carbon dioxide levels, and higher central vascular pressures. IACUC protocol numbers: UPenn (803178), CHOP (997)
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Affiliation(s)
- Joshua W Lampe
- The Feinstein Institute for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
| | - George Bratinov
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Theodore R Weiland
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | | | - Robert A Berg
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Lance B Becker
- The Feinstein Institute for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
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Poli S, Purrucker J, Priglinger M, Ebner M, Sykora M, Diedler J, Bulut C, Popp E, Rupp A, Hametner C. Rapid Induction of COOLing in Stroke Patients (iCOOL1): a randomised pilot study comparing cold infusions with nasopharyngeal cooling. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:582. [PMID: 25346332 PMCID: PMC4234831 DOI: 10.1186/s13054-014-0582-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/08/2014] [Indexed: 01/01/2023]
Abstract
Introduction Induction methods for therapeutic cooling are under investigated. We compared the effectiveness and safety of cold infusions (CI) and nasopharyngeal cooling (NPC) for cooling induction in stroke patients. Methods A prospective, open-label, randomised (1:1), single-centre pilot trial with partially blinded safety endpoint assessment was conducted at the neurointensive care unit of Heidelberg University. Intubated stroke patients with an indication for therapeutic cooling and an intracranial pressure (ICP)/temperature brain probe were randomly assigned to CI (4°C, 2L at 4L/h) or NPC (60L/min for 1 h). Previous data suggested a maximum decrease of tympanic temperature for CI (2.1L within 35 min) after 52 min. Therefore the study period was 1 hour (15 min subperiods I-IV). The brain temperature course was the primary endpoint. Secondary measures included continuous monitoring of neurovital parameters and extracerebral temperatures. Statistical analysis based on repeated-measures analysis of variance. Results Of 221 patients screened, 20 were randomized within 5 months. Infusion time of 2L CI was 33 ± 4 min in 10 patients and 10 patients received NPC for 60 min. During active treatment (first 30 min), brain temperature decreased faster with CI than during NPC (I: −0.31 ± 0.2 versus −0.12 ± 0.1°C, P = 0.008; II: −1.0 ± 0.3 versus −0.49 ± 0.3°C, P = 0.001). In the CI-group, after the infusion was finished, the intervention no longer decreased brain temperature, which increased after 3.5 ± 3.3 min. Oesophageal temperature correlated best with brain temperature during CI and NPC. Tympanic temperature reacted similarly to relative changes of brain temperature during CI, but absolute values slightly differed. CI provoked three severe adverse events during subperiods II-IV (two systolic arterial pressure (SAP), one shivering) compared with four in the NPC-group, all during subperiod I (three SAP, one ICP). Classified as possibly intervention-related, two cases of ventilator failure occurred during NPC. Conclusions In intubated stroke patients, brain cooling is faster during CI than during NPC. Importantly, contrary to previous expectations, brain cooling stopped soon after CI cessation. Oesophageal but neither bladder nor rectal temperature is suited as surrogate for brain temperature during CI and NPC. Several severe adverse events in CI and in NPC demand further studying of safety. Trial registration ClinicalTrials.gov NCT01573117. Registered 31 March 2012 Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0582-1) contains supplementary material, which is available to authorized users.
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Nordberg P, Taccone FS, Castren M, Truhlár A, Desruelles D, Forsberg S, Hollenberg J, Vincent JL, Svensoon L. Design of the PRINCESS trial: pre-hospital resuscitation intra-nasal cooling effectiveness survival study (PRINCESS). BMC Emerg Med 2013; 13:21. [PMID: 24274342 PMCID: PMC4221640 DOI: 10.1186/1471-227x-13-21] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/18/2013] [Indexed: 01/16/2023] Open
Abstract
Background Therapeutic hypothermia (TH, 32-34°C) has been shown to improve neurological outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA) with ventricular tachycardia or fibrillation. Earlier initiation of TH may increase the beneficial effects. Experimental studies have suggested that starting TH during cardiopulmonary resuscitation (CPR) may further enhance its neuroprotective effects. The aim of this study was to evaluate whether intra-arrest TH (IATH), initiated in the field with trans nasal evaporative cooling (TNEC), would provide outcome benefits when compared to standard of care in patients being resuscitated from OHCA. Methods/design We describe the methodology of a multi-centre, randomized, controlled trial comparing IATH delivered through TNEC device (Rhinochill, Benechill Inc., San Diego, CA, USA) during CPR to standard treatment, including TH initiated after hospital admission. The primary outcome is neurological intact survival defined as cerebral performance category 1–2 at 90 days among those patients who are admitted to the hospital. Secondary outcomes include survival at 90 days, proportion of patients achieving a return to spontaneous circulation (ROSC), the proportion of patients admitted alive to the hospital and the proportion of patients achieving target temperature (<34°C) within the first 4 hours since CA. Discussion This ongoing trial will assess the impact of IATH with TNEC, which may be able to rapidly induce brain cooling and have fewer side effects than other methods, such as cold fluid infusion. If this intervention is found to improve neurological outcome, its early use in the pre-hospital setting will be considered as an early neuro-protective strategy in OHCA. Trial registration NCT01400373.
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Affiliation(s)
- Per Nordberg
- Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik, 808, Bruxelles 1070, Belgium.
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Jarrah S, Dziodzio J, Lord C, Fraser GL, Lucas L, Riker RR, Seder DB. Surface cooling after cardiac arrest: effectiveness, skin safety, and adverse events in routine clinical practice. Neurocrit Care 2011; 14:382-8. [PMID: 21249528 DOI: 10.1007/s12028-011-9506-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Effectiveness of cooling and adverse events (AEs) involving skin have not been intensively evaluated in cardiac arrest survivors treated with therapeutic hypothermia (TH) when induced and maintained with a servomechanism-regulated surface cooling system. METHODS Retrospective review of sixty-nine cardiac arrest survivor-events admitted from April 2006-September 2008 who underwent TH using the Medivance Arctic Sun Temperature Management System. A TH database and medical records were reviewed, and nursing interviews conducted. Primary endpoint was time from initiation to target temperature (TT; 32-34 °C). Secondary endpoints were cooling rate, percentage of hypothermia maintenance phase at TT, effect of body-mass index (BMI) on rate of cooling, and AEs. RESULTS Mean time to the target temperature (TT) was 2.78 h; 80% of patients achieved TT within 4 h; all did within 8 h. Patients were at TT for 96.7% of hypothermia maintenance; 17% of patients had >1 hourly temperature measurement outside TT range. Mean cooling rate during induction phase was 1.1 °C/h, and was not associated with BMI. Minor skin injury occurred in 14 (20%) patients; 4 (6%) were device-related. Skin injuries were associated with shock (P = 0.04), and decubitus ulcers were associated with left ventricular ejection fraction <45% (P = 0.004). AEs included shivering (94%), hypokalemia (81%), hyperglycemia (57%), pneumonia (23%), bleeding (22%), post-cooling fever (17%), and bacteremia (9%). CONCLUSIONS The Arctic Sun Temperature Management System was an effective means of performing therapeutic hypothermia after cardiac arrest. Infrequent skin injuries were associated with vasopressor use and low ejection fraction.
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Affiliation(s)
- Salam Jarrah
- Division of Pulmonary and Critical Care Medicine, Maine Medical Center, Portland, ME, USA
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18
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Chenoune M, Lidouren F, Adam C, Pons S, Darbera L, Bruneval P, Ghaleh B, Zini R, Dubois-Randé JL, Carli P, Vivien B, Ricard JD, Berdeaux A, Tissier R. Ultrafast and whole-body cooling with total liquid ventilation induces favorable neurological and cardiac outcomes after cardiac arrest in rabbits. Circulation 2011; 124:901-11, 1-7. [PMID: 21810660 DOI: 10.1161/circulationaha.111.039388] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND In animal models of cardiac arrest, the benefit afforded by hypothermia is closely linked to the rapidity of the decrease in body temperature after resuscitation. Because total liquid ventilation (TLV) with temperature-controlled perfluorocarbons induces a very rapid and generalized cooling, we aimed to determine whether this could limit the post-cardiac arrest syndrome in a rabbit model. We especially focused on neurological, cardiac, pulmonary, liver and kidney dysfunctions. METHODS AND RESULTS Anesthetized rabbits were submitted to either 5 or 10 minutes of untreated ventricular fibrillation. After cardiopulmonary resuscitation and resumption of a spontaneous circulation, the animals underwent either normothermic life support (control) or therapeutic hypothermia induced by TLV. The latter procedure decreased esophageal and tympanic temperatures to 32°C to 33°C within only 10 minutes. After rewarming, the animals submitted to TLV exhibited an attenuated neurological dysfunction and decreased mortality 7 days later compared with control. The neuroprotective effect of TLV was confirmed by a significant reduction in brain histological damages. We also observed limitation of myocardial necrosis, along with a decrease in troponin I release and a reduced myocardial caspase 3 activity, with TLV. The beneficial effects of TLV were directly related to the rapidity of hypothermia induction because neither conventional cooling (cold saline infusion plus external cooling) nor normothermic TLV elicited a similar protection. CONCLUSIONS Ultrafast cooling instituted by TLV exerts potent neurological and cardiac protection in an experimental model of cardiac arrest in rabbits. This could be a relevant approach to provide a global and protective hypothermia against the post-cardiac arrest syndrome.
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Gupta D. Transnasal cooling: a Pandora's box of transnasal patho-physiology. Med Hypotheses 2011; 77:275-7. [PMID: 21600699 DOI: 10.1016/j.mehy.2011.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/11/2011] [Accepted: 04/28/2011] [Indexed: 11/18/2022]
Abstract
The innovative concept of transnasal evaporative cooling for therapeutic hypothermia in cardio-pulmonary-cerebro-resuscitation has therapeutic implications with evidence of rapid and selective brain cooling; however, this author wants to elicit that this concept may hold answers for many physiological phenomena which have not been explored or completely understood up till now. To affirm the physiological role of transnasal cooling, the innovative non-invasive brain temperature monitoring can help the investigators to explore and understand the following transnasal pathophysiological phenomena: (1) understanding correlation of brain temperature and sinus headache secondary to nasal blockade, (2) exploring the therapeutic role of nasal oxygen for prevention of delirium in intubated patients, (3) realizing the impact of controlled enclosed environments on the mood and affect of the inhabitants, (4) understanding the etio-pathogenesis of claustrophobia after excluding the confounding factors of morbid obesity, severe cardiopulmonary disease and incapacitating musculoskeletal diseases, (5) exploring the anthropological role of male pattern of moustache, beard and hair loss, and (6) possible development of a coolant moustache as proposed by the author. In summary, transnasal pathophysiology offers many promising lines of fruitful research to explore the non-olfactory physiological functions of nose in human beings.
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Affiliation(s)
- Deepak Gupta
- Department of Anesthesiology, Wayne State University/Detroit Medical Center, School of Medicine, Box No. 162, 3990 John R, Detroit, MI 48201, USA.
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21
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Rebuttal from Nybo and Secher. J Appl Physiol (1985) 2011; 110:573-4. [PMID: 21304013 DOI: 10.1152/japplphysiol.00992.2010c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Maaret C. Response: the use of hypothermia therapy in cardiac arrest survivors. Ther Hypothermia Temp Manag 2011; 1:115-6. [PMID: 24717040 DOI: 10.1089/ther.2011.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Castrén Maaret
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet , Stockholm, Sweden
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Garrett JS, Studnek JR, Blackwell T, Vandeventer S, Pearson DA, Heffner AC, Reades R. The association between intra-arrest therapeutic hypothermia and return of spontaneous circulation among individuals experiencing out of hospital cardiac arrest. Resuscitation 2010; 82:21-5. [PMID: 21036449 DOI: 10.1016/j.resuscitation.2010.09.473] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/05/2010] [Accepted: 09/19/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Therapeutic hypothermia has been shown to improve both mortality and neurologic outcomes following pulseless ventricular tachycardia and fibrillation. Animal data suggest intra-arrest induction of therapeutic hypothermia (IATH) improves frequency of return of spontaneous circulation (ROSC). Our objective was to evaluate the association between IATH and ROSC. METHODS This was a retrospective analysis of individuals experiencing non-traumatic cardiac arrest in a large metropolitan area during a 12-month period. Six months into the study a prehospital IATH protocol was instituted whereby patients received 2000ml of 4°C normal saline directly after obtaining IV/IO access. The main outcome variables were prehospital ROSC, survival to admission, and to discharge. A secondary analysis was conducted to assess the relationship between the quantity of cold saline infused and the likelihood of prehospital ROSC. RESULTS 551 patients met inclusion criteria with all the elements available for data analysis. Rates of prehospital ROSC were 36.5% versus 26.9% (OR 1.83; 95% CI 1.19-2.81) in patients who received IATH versus normothermic resuscitation respectively. While the frequency of survival to hospital admission and discharge were increased among those receiving IATH, the differences did not reach statistical significance. The secondary analysis found a linear association between the amount of cold saline infused and the likelihood of prehospital ROSC. CONCLUSION The infusion of 4°C normal saline during the intra-arrest period may improve rate of ROSC even at low fluid volumes. Further study is required to determine if intra-arrest cooling has a beneficial effect on rates of ROSC, mortality, and neurologic function.
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Affiliation(s)
- John S Garrett
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC, USA
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