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Sanfilippo F, Messina A, Scolletta S, Bignami E, Morelli A, Cecconi M, Landoni G, Romagnoli S. The "CHEOPS" bundle for the management of Left Ventricular Diastolic Dysfunction in critically ill patients: an experts' opinion. Anaesth Crit Care Pain Med 2023; 42:101283. [PMID: 37516408 DOI: 10.1016/j.accpm.2023.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
The impact of left ventricular (LV) diastolic dysfunction (DD) on the outcome of patients with heart failure was established over three decades ago. Nevertheless, the relevance of LVDD for critically ill patients admitted to the intensive care unit has seen growing interest recently, and LVDD is associated with poor prognosis. Whilst an assessment of LV diastolic function is desirable in critically ill patients, treatment options for LVDD are very limited, and pharmacological possibilities to rapidly optimize diastolic function have not been found yet. Hence, a proactive approach might have a substantial role in improving the outcomes of these patients. Recalling historical Egyptian parallelism suggesting that Doppler echocardiography has been the "Rosetta stone" to decipher the study of LV diastolic function, we developed a potentially useful acronym for physicians at the bedside to optimize the management of critically ill patients with LVDD with the application of the bundle. We summarized the bundle under the acronym of the famous ancient Egyptian pharaoh CHEOPS: Chest Ultrasound, combining information from echocardiography and lung ultrasound; HEmodynamics assessment, with careful evaluation of heart rate and rhythm, as well as afterload and vasoactive drugs; OPtimization of mechanical ventilation and pulmonary circulation, considering the effects of positive end-expiratory pressure on both right and left heart function; Stabilization, with cautious fluid administration and prompt fluid removal whenever judged safe and valuable. Notably, the CHEOPS bundle represents experts' opinion and are not targeted at the initial resuscitation phase but rather for the optimization and subsequent period of critical illness.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy; Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy.
| | - Antonio Messina
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center IRCCS, 20089, Rozzano, Milan, Italy.
| | - Sabino Scolletta
- Anesthesia and Intensive Care Unit, University Hospital of Siena, University of Siena, Siena, Italy.
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Andrea Morelli
- Department Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Roma, Italy.
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center IRCCS, 20089, Rozzano, Milan, Italy.
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Stefano Romagnoli
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Department of Anetshesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Yamada KP, Kariya T, Aikawa T, Ishikawa K. Effects of Therapeutic Hypothermia on Normal and Ischemic Heart. Front Cardiovasc Med 2021; 8:642843. [PMID: 33659283 PMCID: PMC7919696 DOI: 10.3389/fcvm.2021.642843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Therapeutic hypothermia has been used for treating brain injury after out-of-hospital cardiac arrest. Its potential benefit on minimizing myocardial ischemic injury has been explored, but clinical evidence has yet to confirm positive results in preclinical studies. Importantly, therapeutic hypothermia for myocardial infarction is unique in that it can be initiated prior to reperfusion, in contrast to its application for brain injury in resuscitated cardiac arrest patients. Recent advance in cooling technology allows more rapid cooling of the heart than ever and new clinical trials are designed to examine the efficacy of rapid therapeutic hypothermia for myocardial infarction. In this review, we summarize current knowledge regarding the effect of hypothermia on normal and ischemic hearts and discuss issues to be solved in order to realize its clinical application for treating acute myocardial infarction.
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Affiliation(s)
- Kelly P Yamada
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Taro Kariya
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Tadao Aikawa
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kiyotake Ishikawa
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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3
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Abawi D, Faragli A, Schwarzl M, Manninger M, Zweiker D, Kresoja KP, Verderber J, Zirngast B, Maechler H, Steendijk P, Pieske B, Post H, Alogna A. Cardiac power output accurately reflects external cardiac work over a wide range of inotropic states in pigs. BMC Cardiovasc Disord 2019; 19:217. [PMID: 31615415 PMCID: PMC6792198 DOI: 10.1186/s12872-019-1212-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/26/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cardiac power output (CPO), derived from the product of cardiac output and mean aortic pressure, is an important yet underexploited parameter for hemodynamic monitoring of critically ill patients in the intensive-care unit (ICU). The conductance catheter-derived pressure-volume loop area reflects left ventricular stroke work (LV SW). Dividing LV SW by time, a measure of LV SW min- 1 is obtained sharing the same unit as CPO (W). We aimed to validate CPO as a marker of LV SW min- 1 under various inotropic states. METHODS We retrospectively analysed data obtained from experimental studies of the hemodynamic impact of mild hypothermia and hyperthermia on acute heart failure. Fifty-nine anaesthetized and mechanically ventilated closed-chest Landrace pigs (68 ± 1 kg) were instrumented with Swan-Ganz and LV pressure-volume catheters. Data were obtained at body temperatures of 33.0 °C, 38.0 °C and 40.5 °C; before and after: resuscitation, myocardial infarction, endotoxemia, sevoflurane-induced myocardial depression and beta-adrenergic stimulation. We plotted LVSW min- 1 against CPO by linear regression analysis, as well as against the following classical indices of LV function and work: LV ejection fraction (LV EF), rate-pressure product (RPP), triple product (TP), LV maximum pressure (LVPmax) and maximal rate of rise of LVP (LV dP/dtmax). RESULTS CPO showed the best correlation with LV SW min- 1 (r2 = 0.89; p < 0.05) while LV EF did not correlate at all (r2 = 0.01; p = 0.259). Further parameters correlated moderately with LV SW min- 1 (LVPmax r2 = 0.47, RPP r2 = 0.67; and TP r2 = 0.54). LV dP/dtmax correlated worst with LV SW min- 1 (r2 = 0.28). CONCLUSION CPO reflects external cardiac work over a wide range of inotropic states. These data further support the use of CPO to monitor inotropic interventions in the ICU.
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Affiliation(s)
- Dawud Abawi
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Alessandro Faragli
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Michael Schwarzl
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf Martinistr 52, 20246, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Martin Manninger
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz, Austria
| | - David Zweiker
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz, Austria
| | - Karl-Patrik Kresoja
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Leipzig Heart Institute at Heart Center Leipzig, Leipzig, Germany
| | - Jochen Verderber
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz , Auenbruggerplatz 15, 8036 Graz, Austria
| | - Birgit Zirngast
- Department of Cardiothoracic Surgery, Medical University of Graz Auenbruggerplatz 29, 8036 Graz, Graz, Austria
| | - Heinrich Maechler
- Department of Cardiothoracic Surgery, Medical University of Graz Auenbruggerplatz 29, 8036 Graz, Graz, Austria
| | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, PO 9600, 2300 RC, Leiden, The Netherlands
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Heiner Post
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, 45468, Mülheim, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
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Fuernau G, Thiele H. Response by Fuernau and Thiele to Letters Regarding Article, "Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction: Randomized SHOCK-COOL Trial". Circulation 2019; 140:e158-e159. [PMID: 31306066 DOI: 10.1161/circulationaha.119.041188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Georg Fuernau
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Luebeck, University Hospital Schleswig-Holstein, University of Luebeck and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany (G.F.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (H.T.)
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Fuernau G, Beck J, Desch S, Eitel I, Jung C, Erbs S, Mangner N, Lurz P, Fengler K, Jobs A, Vonthein R, de Waha-Thiele S, Sandri M, Schuler G, Thiele H. Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction. Circulation 2019; 139:448-457. [DOI: 10.1161/circulationaha.117.032722] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Georg Fuernau
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Luebeck, University Hospital Schleswig-Holstein (G.F., S.D., I.E., A.J., S.d.W.-T), University of Luebeck, Germany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung [DZHK]), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany (G.F., S.D., I.E., A.J., S.d.W.-T)
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Johannes Beck
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Steffen Desch
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Luebeck, University Hospital Schleswig-Holstein (G.F., S.D., I.E., A.J., S.d.W.-T), University of Luebeck, Germany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung [DZHK]), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany (G.F., S.D., I.E., A.J., S.d.W.-T)
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Luebeck, University Hospital Schleswig-Holstein (G.F., S.D., I.E., A.J., S.d.W.-T), University of Luebeck, Germany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung [DZHK]), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany (G.F., S.D., I.E., A.J., S.d.W.-T)
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Christian Jung
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany (C.J.)
| | - Sandra Erbs
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Norman Mangner
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Karl Fengler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Alexander Jobs
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Luebeck, University Hospital Schleswig-Holstein (G.F., S.D., I.E., A.J., S.d.W.-T), University of Luebeck, Germany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung [DZHK]), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany (G.F., S.D., I.E., A.J., S.d.W.-T)
| | - Reinhard Vonthein
- Institute of Medical Biometry and Statistics and Center for Clinical Trials (R.V.), University of Luebeck, Germany
| | - Suzanne de Waha-Thiele
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Luebeck, University Hospital Schleswig-Holstein (G.F., S.D., I.E., A.J., S.d.W.-T), University of Luebeck, Germany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung [DZHK]), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany (G.F., S.D., I.E., A.J., S.d.W.-T)
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Marcus Sandri
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Gerhard Schuler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (G.F., J.B., S.D., I.E., S.E., N.M., P.L., K.F., S.d.W.-T, M.S., G.S., H.T.)
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Sanfilippo F, Scolletta S, Morelli A, Vieillard-Baron A. Practical approach to diastolic dysfunction in light of the new guidelines and clinical applications in the operating room and in the intensive care. Ann Intensive Care 2018; 8:100. [PMID: 30374644 PMCID: PMC6206316 DOI: 10.1186/s13613-018-0447-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/20/2018] [Indexed: 12/26/2022] Open
Abstract
There is growing evidence both in the perioperative period and in the field of intensive care (ICU) on the association between left ventricular diastolic dysfunction (LVDD) and worse outcomes in patients. The recent American Society of Echocardiography and European Association of Cardiovascular Imaging joint recommendations have tried to simplify the diagnosis and the grading of LVDD. However, both an often unknown pre-morbid LV diastolic function and the presence of several confounders-i.e., use of vasopressors, positive pressure ventilation, volume loading-make the proposed parameters difficult to interpret, especially in the ICU. Among the proposed parameters for diagnosis and grading of LVDD, the two tissue Doppler imaging-derived variables e' and E/e' seem most reliable. However, these are not devoid of limitations. In the present review, we aim at rationalizing the applicability of the recent recommendations to the perioperative and ICU areas, discussing the clinical meaning and echocardiographic findings of different grades of LVDD, describing the impact of LVDD on patients' outcomes and providing some hints on the management of patients with LVDD.
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Affiliation(s)
- F. Sanfilippo
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - S. Scolletta
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - A. Morelli
- Department of Anaesthesiology and Intensive Care, University of Rome, “La Sapienza”, Rome, Italy
| | - A. Vieillard-Baron
- Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France
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7
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Abstract
Evidence from animal models indicates that lowering temperature by a few degrees can produce substantial neuroprotection. In humans, hypothermia has been found to be neuroprotective with a significant impact on mortality and long-term functional outcome only in cardiac arrest and neonatal hypoxic-ischemic encephalopathy. Clinical trials have explored the potential role of maintaining normothermia and treating fever in critically ill brain injured patients. This review concentrates on basic concepts to understand the physiologic interactions of thermoregulation, effects of thermal modulation in critically ill patients, proposed mechanisms of action of temperature modulation, and practical aspects of targeted temperature management.
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8
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Abstract
Evidence from animal models indicates that lowering temperature by a few degrees can produce substantial neuroprotection. In humans, hypothermia has been found to be neuroprotective with a significant impact on mortality and long-term functional outcome only in cardiac arrest and neonatal hypoxic-ischemic encephalopathy. Clinical trials have explored the potential role of maintaining normothermia and treating fever in critically ill brain injured patients. This review concentrates on basic concepts to understand the physiologic interactions of thermoregulation, effects of thermal modulation in critically ill patients, proposed mechanisms of action of temperature modulation, and practical aspects of targeted temperature management.
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Affiliation(s)
- Fred Rincon
- Division of Critical Care and Neurotrauma, Department of Neurology, Sidney-Kimmel College of Medicine, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA; Division of Critical Care and Neurotrauma, Department of Neurological Surgery, Sidney-Kimmel College of Medicine, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA.
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9
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Staer-Jensen H, Sunde K, Nakstad ER, Eritsland J, Andersen GØ. Comparison of three haemodynamic monitoring methods in comatose post cardiac arrest patients. SCAND CARDIOVASC J 2018; 52:141-148. [PMID: 29544369 DOI: 10.1080/14017431.2018.1450992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Haemodynamic monitoring during post arrest care is important to optimise treatment. We compared stroke volume measured by minimally-invasive monitoring devices with or without thermodilution calibration, and transthoracic echocardiography (TTE), and hypothesised that thermodilution calibration would give stroke volume index (SVI) more in agreement with TTE during targeted temperature management (TTM). DESIGN Comatose out-of-hospital cardiac arrest survivors receiving TTM (33 °C for 24 hrs) underwent haemodynamic monitoring with arterial pulse contour analyses with (PiCCO2®) and without (FloTrac®/Vigileo® monitor®) transpulmonary thermodilution calibration. Haemodynamic parameters were collected simultaneously every fourth hour during TTM (hypothermia) and (normothermia). SVI was measured with TTE during hypothermia and normothermia. Bland-Altman analyses were used for determination of SVI bias (±1SD). RESULTS Twenty-six patients were included, of whom 77% had initial shockable rhythm and 52% discharged with good outcome. SVI (bias ±2SD) between PiCCO (after thermodilution calibration) vs FloTrac/Vigileo, TTE vs FloTrac/Vigileo and TTE vs PiCCO were 1.4 (±25.8), -1.9 (±19.8), 0.06 (±18.5) ml/m2 during hypothermia and 9.7 (±23.9), 1.0 (±17.4), -7.2 (±12.8) ml/m2 during normothermia. Continuous SVI measurements between PiCCO and FloTrac/Vigileo during hypothermia at reduced SVI (<35 ml/m2) revealed low bias and relatively narrow limits of agreement (0.5 ± 10.2 ml/m2). CONCLUSION We found low bias, but relatively wide limits of agreement in SV with PiCCO, FloTrac/Vigileo and TTE during TTM treatment. The methods are not interchangeable. Precision was not improved by transpulmonary thermodilution calibration during hypothermia.
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Affiliation(s)
- Henrik Staer-Jensen
- a Department of Anaesthesiology, Division of Emergencies and Critical Care , Oslo University Hospital , Oslo , Norway
| | - Kjetil Sunde
- a Department of Anaesthesiology, Division of Emergencies and Critical Care , Oslo University Hospital , Oslo , Norway.,b Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Espen Rostrup Nakstad
- c Norwegian National Unit for CBRNE Medicine, Division of Medicine , Oslo University Hospital , Oslo , Norway
| | - Jan Eritsland
- d Department of Cardiology, Division of Medicine , Oslo University Hospital , Oslo , Norway.,e Center for Heart Failure Research , University of Oslo , Oslo , Norway
| | - Geir Øystein Andersen
- d Department of Cardiology, Division of Medicine , Oslo University Hospital , Oslo , Norway.,e Center for Heart Failure Research , University of Oslo , Oslo , Norway
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10
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Haddad SMH, Samani A. A finite element model of myocardial infarction using a composite material approach. Comput Methods Biomech Biomed Engin 2017; 21:33-46. [PMID: 29252005 DOI: 10.1080/10255842.2017.1416355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Computational models are effective tools to study cardiac mechanics under normal and pathological conditions. They can be used to gain insight into the physiology of the heart under these conditions while they are adaptable to computer assisted patient-specific clinical diagnosis and therapeutic procedures. Realistic cardiac mechanics models incorporate tissue active/passive response in conjunction with hyperelasticity and anisotropy. Conventional formulation of such models leads to mathematically-complex problems usually solved by custom-developed non-linear finite element (FE) codes. With a few exceptions, such codes are not available to the research community. This article describes a computational cardiac mechanics model developed such that it can be implemented using off-the-shelf FE solvers while tissue pathologies can be introduced in the model in a straight-forward manner. The model takes into account myocardial hyperelasticity, anisotropy, and active contraction forces. It follows a composite tissue modeling approach where the cardiac tissue is decomposed into two major parts: background and myofibers. The latter is modelled as rebars under initial stresses mimicking the contraction forces. The model was applied in silico to study the mechanics of infarcted left ventricle (LV) of a canine. End-systolic strain components, ejection fraction, and stress distribution attained using this LV model were compared quantitatively and qualitatively to corresponding data obtained from measurements as well as to other corresponding LV mechanics models. This comparison showed very good agreement.
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Affiliation(s)
- Seyyed M H Haddad
- a Graduate Program in Biomedical Engineering, Western University , London, Ontario , Canada
| | - Abbas Samani
- a Graduate Program in Biomedical Engineering, Western University , London, Ontario , Canada.,b Department of Medical Biophysics , Western University , London, Ontario , Canada.,c Department of Electrical and Computer Engineering , Western University , London, Ontario , Canada.,d Imaging Research Laboratories , Robarts Research Institute (RRI) , London, Ontario , Canada
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11
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An MY, Li Y, Chen WH, Zhang Y, Wu YN, Sun K, Pan YY, Yin YQ, Lou JS. Effects of non-invasive remote ischemic conditioning on rehabilitation after myocardial infarction. Biochem Biophys Res Commun 2017; 488:278-284. [PMID: 28479248 DOI: 10.1016/j.bbrc.2017.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022]
Abstract
Recent studies have demonstrated that remote ischemic conditioning (RIC) creates cardioprotection against ischemia/reperfusion injury and myocardial infarction (MI); however, the effects of non-invasive remote ischemic conditioning (nRIC) on prognosis and rehabilitation after MI (post-MI) remain unknown. We successfully established MI models involving healthy adult male Sprague-Dawley rats. The nRIC group repeatedly underwent 5 min of ischemia and 5 min of reperfusion in the left hind limb for three cycles every other day until weeks 4, 6, and 8 after MI. nRIC improved cardiac hemodynamic function and mitochondrial respiratory function through increasing myocardial levels of mitochondrial respiratory chain complexes I, II, III, IV, and adenosine triphosphate (ATP) and decreasing the activity of nitric oxide synthase (NOS). nRIC could inhibit cardiomyocytes apoptosis and reduce myocardium injury through raising the expression of Bcl-2 and reduced the content of creatine kinase-MB, cardiac troponin I and Bax. The results indicated that long-term nRIC could accelerate recovery and improve prognosis and rehabilitation in post-MI rats.
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Affiliation(s)
- Meng-Yao An
- Department of Pharmacology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, PR China
| | - Yan Li
- Department of Pharmacology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, PR China
| | - Wen-Hua Chen
- Department of Pharmacy, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, PR China
| | - Ying Zhang
- Department of Pharmacology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, PR China
| | - Yan-Na Wu
- Department of Pharmacology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, PR China
| | - Kai Sun
- Department of Pharmacology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, PR China
| | - Ying-Ying Pan
- Department of Pharmacology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, PR China
| | - Yong-Qiang Yin
- Department of Pharmacology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, PR China
| | - Jian-Shi Lou
- Department of Pharmacology, College of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, PR China.
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Chavez LO, Leon M, Einav S, Varon J. Editor's Choice- Inside the cold heart: A review of therapeutic hypothermia cardioprotection. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:130-141. [PMID: 26714973 DOI: 10.1177/2048872615624242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Luis O Chavez
- 1 University General Hospital, Houston, USA.,2 Universidad Autonoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Mexico
| | - Monica Leon
- 1 University General Hospital, Houston, USA.,3 Universidad Popular Autonoma del Estado de Puebla, Facultad de Medicina Puebla, Mexico
| | - Sharon Einav
- 4 Shaare Zedek Medical Center and Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel
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Inotropic Effects of Experimental Hyperthermia and Hypothermia on Left Ventricular Function in Pigs-Comparison With Dobutamine. Crit Care Med 2016; 44:e158-67. [PMID: 26474110 DOI: 10.1097/ccm.0000000000001358] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The results from the recent Targeted Temperature Management trial raised the question whether cooling or merely the avoidance of fever mediates better neurologic outcome in resuscitated patients. As temperature per se is a major determinant of cardiac function, we characterized the effects of hyperthermia (40.5°C), normothermia (38.0°C), and mild hypothermia (33.0°C) on left ventricular contractile function in healthy pigs and compared them with dobutamine infusion. DESIGN Animal study. SETTING Large animal facility, Medical University of Graz, Graz, Austria. SUBJECTS Nine anesthetized and mechanically ventilated closed-chest Landrace pigs (67 ± 2 kg). INTERVENTIONS Core body temperature was controlled using an intravascular device. At each temperature step, IV dobutamine was titrated to double maximum left ventricular dP/dt (1.8 ± 0.1 µg/kg/min at normothermia). Left ventricular pressure-volume relationships were assessed during short aortic occlusions. Left ventricular contractility was assessed by the calculated left ventricular end-systolic volume at an end-systolic left ventricular pressure of 100 mm Hg. MEASUREMENTS AND MAIN RESULTS Heart rate (98 ± 4 vs 89 ± 4 vs 65 ± 2 beats/min; all p < 0.05) and cardiac output (6.7 ± 0.3 vs 6.1 ± 0.3 vs 4.4 ± 0.2 L/min) decreased with cooling from hyperthermia to normothermia and mild hypothermia, whereas left ventricular contractility increased (left ventricular end-systolic volume at a pressure of 100 mm Hg: 74 ± 5 mL at hyperthermia, 52 ± 4 mL at normothermia, and 41 ± 3 mL at mild hypothermia; all p < 0.05). The effect of cooling on left ventricular end-systolic volume at a pressure of 100 mm Hg (hyperthermia to normothermia: -28% ± 3% and normothermia to mild hypothermia: -20% ± 5%) was of comparable effect size as dobutamine at a given temperature (hyperthermia: -28% ± 4%, normothermia: -27% ± 6%, and mild hypothermia: -27% ± 9%). CONCLUSIONS Cooling from hyperthermia to normothermia and from normothermia to mild hypothermia increased left ventricular contractility to a similar degree as a significant dose of dobutamine in the normal porcine heart. These data indicate that cooling can reduce the need for positive inotropes and that lower rather than higher temperatures are appropriate for the resuscitated failing heart.
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Schwarzl M, Alogna A, Zirngast B, Steendijk P, Verderber J, Zweiker D, Huber S, Maechler H, Pieske BM, Post H. Mild hypothermia induces incomplete left ventricular relaxation despite spontaneous bradycardia in pigs. Acta Physiol (Oxf) 2015; 213:653-63. [PMID: 25515791 DOI: 10.1111/apha.12439] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/11/2014] [Accepted: 12/10/2014] [Indexed: 01/08/2023]
Abstract
AIM Mild hypothermia (MH) decreases left ventricular (LV) end-diastolic capacitance. We sought to clarify whether this results from incomplete relaxation. METHODS Ten anaesthetized pigs were cooled from normothermia (NT, 38 °C) to MH (33 °C). LV end-diastolic pressure (LVPed), volume (LVVed) and pressure-volume relationships (EDPVRs) were determined during stepwise right atrial pacing. LV capacitance (i.e. LVVed at LVPed of 10 mmHg, LV VPed10) was derived from the EDPVR. Pacing-induced changes of diastolic indices (LVPed, LVVed and LV VPed10) were analysed as a function of (i) heart rate and (ii) the ratio between diastolic time interval (t-dia) and LV isovolumic relaxation constant τ, which was calculated using a logistic fit (τL ) and monoexponential fit with zero asymptote (τZ ) and nonzero asymptote (τNZ ). RESULTS Mild hypothermia decreased heart rate (85 ± 4 to 68 ± 3 bpm), increased τL (22 ± 1 to 57 ± 4 ms), τZ (26 ± 2 to 56 ± 5 ms) and τNZ (41 ± 1 to 96 ± 5 ms), decreased t-dia/τ ratios, and shifted the EDPVR leftwards compared to NT (all P < 0.05). During NT, pacing at ≥140 bpm shifted the EDPVR progressively leftwards. During MH, relationships between diastolic indices and heart rate were shifted towards lower heart rates compared to NT. However, relationships between diastolic indices and t-dia/τ during NT and MH were superimposable. CONCLUSION We conclude that the loss of LV end-diastolic capacitance during MH can be explained at least in part by slowed LV relaxation. MH thereby is an example of incomplete LV relaxation at a spontaneous low heart rate. Caution may be advised, when heart rate is increased in patients treated with MH.
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Affiliation(s)
- M. Schwarzl
- Department of General and Interventional Cardiology; University Heart Center Hamburg-Eppendorf; Hamburg Germany
| | - A. Alogna
- Department of Cardiology; Medical University of Graz; Graz Austria
| | - B. Zirngast
- Department of Cardiothoracic Surgery; Medical University of Graz; Graz Austria
| | - P. Steendijk
- Department of Cardiology; Leiden University Medical Center; Leiden the Netherlands
| | - J. Verderber
- Department of Cardiology; Medical University of Graz; Graz Austria
| | - D. Zweiker
- Department of Cardiology; Medical University of Graz; Graz Austria
| | - S. Huber
- Department of Cardiothoracic Surgery; Medical University of Graz; Graz Austria
| | - H. Maechler
- Department of Cardiothoracic Surgery; Medical University of Graz; Graz Austria
| | - B. M. Pieske
- Department of Cardiology; Charit e-Universitaetsmedizin Berlin; Campus Virchow-Klinikum; Berlin Germany
| | - H. Post
- Department of Cardiology; Charit e-Universitaetsmedizin Berlin; Campus Virchow-Klinikum; Berlin Germany
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Kerans V, Espinoza A, Skulstad H, Halvorsen PS, Edvardsen T, Bugge JF. Systolic left ventricular function is preserved during therapeutic hypothermia, also during increases in heart rate with impaired diastolic filling. Intensive Care Med Exp 2015. [PMID: 26215808 PMCID: PMC4513019 DOI: 10.1186/s40635-015-0041-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Systolic left ventricular function during therapeutic hypothermia is found both to improve and to decline. We hypothesized that this discrepancy would depend on the heart rate and the variables used to assess systolic function. Methods In 16 pigs, cardiac performance was assessed by measurements of invasive pressures and thermodilution cardiac output and with 2D strain echocardiography. Left ventricle (LV) volumes, ejection fraction (EF), transmitral flow, and circumferential and longitudinal systolic strain were measured. Miniaturized ultrasonic transducers were attached to the epicardium of the LV to obtain M-mode images, systolic thickening, and diastolic thinning velocities and to determine LV pressure-wall dimension relationships. Preload recruitable stroke work (PRSW) was calculated. Measurements were performed at 38 and 33°C at spontaneous and paced heart rates, successively increased in steps of 20 up to the toleration limit. Effects of temperature and heart rate were compared in a mixed model analysis. Results Hypothermia reduced heart rate from 87 ± 10 (SD) to 76 ± 11 beats/min without any changes in LV stroke volume, end-diastolic volume, EF, strain values, or PRSW. Systolic wall thickening velocity (S′) and early diastolic wall thinning velocity decreased by approximately 30%, making systolic duration longer through a prolonged and slow contraction and changing the diastolic filling pattern from predominantly early towards late. Pacing reduced diastolic duration much more during hypo- than during normothermia, and combined with slow myocardial relaxation, incomplete relaxation occurred with all pacing rates. Pacing did not affect S′ or PRSW at physiological heart rates, but stroke volume, end-diastolic volume, and strain were reduced as a consequence of reduced diastolic filling and much more accentuated during hypothermia. At the ultimate tolerable heart rate during hypothermia, S′ decreased, probably as a consequence of myocardial hypoperfusion due to sustained ventricular contraction throughout a very short diastole. Conclusions Systolic function was maintained at physiological heart rates during therapeutic hypothermia. Reduced tolerance to increases in heart rate was caused by lack of ventricular filling due to diastolic dysfunction and shorter diastolic duration.
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Affiliation(s)
- Viesturs Kerans
- Department of Anesthesiology, Rikshospitalet, Division of Emergencies and Critical Care, Oslo University Hospital, Postbox 4950, Nydalen, N-0424, Oslo, Norway,
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Bro-Jeppesen J, Hassager C, Wanscher M, Østergaard M, Nielsen N, Erlinge D, Friberg H, Køber L, Kjaergaard J. Targeted Temperature Management at 33°C Versus 36°C and Impact on Systemic Vascular Resistance and Myocardial Function After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv 2014; 7:663-72. [DOI: 10.1161/circinterventions.114.001556] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- John Bro-Jeppesen
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Christian Hassager
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Michael Wanscher
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Morten Østergaard
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Niklas Nielsen
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Hans Friberg
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Lars Køber
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
| | - Jesper Kjaergaard
- From the Departments of Cardiology (J.B.-J., C.H., L.K., J.K.) and Cardiothoracic Anesthesia (M.W., M.O.), The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden (N.N.); and Departments of Cardiology (D.E.) and Anesthesia and Intensive Care (H.F.), Lund University, Skåne University Hospital, Lund, Sweden
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Ohler A, Post H, Schmidt-Schweda S, Pieske B. Reply to Letter: Is hypothermia beneficial even for the depressed heart after the resumption of spontaneous circulation (ROSC) from out-of-hospital cardiac arrest (OHCA)? Resuscitation 2014; 85:e95-6. [DOI: 10.1016/j.resuscitation.2014.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
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Mild Hypothermia Attenuates Circulatory and Pulmonary Dysfunction During Experimental Endotoxemia*. Crit Care Med 2013; 41:e401-10. [DOI: 10.1097/ccm.0b013e31829791da] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Nolan JP, Ornato JP, Parr MJ, Perkins GD, Soar J. Resuscitation highlights in 2012. Resuscitation 2013; 84:129-36. [DOI: 10.1016/j.resuscitation.2013.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 12/19/2022]
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Hale SL, Herring MJ, Kloner RA. Delayed treatment with hypothermia protects against the no-reflow phenomenon despite failure to reduce infarct size. J Am Heart Assoc 2013; 2:e004234. [PMID: 23525431 PMCID: PMC3603258 DOI: 10.1161/jaha.112.004234] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many studies have shown that when hypothermia is started after coronary artery reperfusion (CAR), it is ineffective at reducing necrosis. However, some suggest that hypothermia may preferentially reduce no-reflow. Our aim was to test the effects of hypothermia on no-reflow when initiated close to reperfusion and 30 minutes after reperfusion, times not associated with a protective effect on myocardial infarct size. METHODS AND RESULTS Rabbits received 30 minutes coronary artery occlusion/3 hours CAR. In protocol 1, hearts were treated for 1 hour with topical hypothermia (myocardial temperature ≈32°C) initiated at 5 minutes before or 5 minutes after CAR, and the results were compared with a normothermic group. In protocol 2, hypothermia was delayed until 30 minutes after CAR and control hearts remained normothermic. In protocol 1, risk zones were similar and infarct size was not significantly reduced by hypothermia initiated close to CAR. However, the no-reflow defect was significantly reduced by 43% (5 minutes before CAR) and 38% (5 minutes after CAR) in hypothermic compared with normothermic hearts (P=0.004, ANOVA, P=ns between the 2 treated groups). In protocol 2, risk zones and infarct sizes were similar, but delayed hypothermia significantly reduced no-reflow in hypothermic hearts by 30% (55±6% of the necrotic region in hypothermia group versus 79±6% with normothermia, P=0.008). CONCLUSION These studies suggest that treatment with hypothermia reduces no-reflow even when initiated too late to reduce infarct size and that the microvasculature is especially receptive to the protective properties of hypothermia and confirm that microvascular damage is in large part a form of true reperfusion injury.
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Affiliation(s)
- Sharon L Hale
- The Heart Institute of Good Samaritan Hospital, Los Angeles, CA 90017, USA.
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