Does the rate of rewarming from profound hypothermic arrest influence the outcome in a swine model of lethal hemorrhage?

Hasan B. Alam, Peter M Rhee, Kaneatsu Honma, Huazhen Chen, Eduardo C. Ayuste, Tom Lin, Kevin Toruno, Tina Mehrani, Caroline Engel, Zheng Chen, Larry M. Gentilello, William B. Long, Frederick A. Moore, Lawrence H. Pitt, Hasan B. Alam

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Background: Rapid induction of profound hypothermic arrest (suspended animation) can provide valuable time for the repair of complex injuries and improve survival. The optimal rate for re-warming from a state of profound hypothermia is unknown. This experiment was designed to test the impact of different warming rates on outcome in a swine model of lethal hemorrhage from complex vascular injuries. Methods: Uncontrolled lethal hemorrhage was induced in 40 swine (80-120 Ibs) by creating an iliac artery and vein injury, followed 30 minutes later (simulating transport time) by laceration of the descending thoracic aorta. Through a thoracotomy approach, a catheter was placed in the aorta and hyperkalemic organ preservation solution was infused on cardiopulmonary bypass to rapidly (2°C/min) induce profound (10°C) hypothermia. Vascular injuries were repaired during 60 minutes of hypothermic arrest. The 4 groups (n = 10/group) included normothermic controls (NC) where core temperature was maintained between 36 to 37°C, and re-warming from profound hypothermia at rates of: 0.25°C/min (slow), 0.5°C/min (medium), or 1°C/min (fast). Hyperkalemia was reversed during the hypothermic arrest period, and blood was infused for resuscitation during re-warming. After discontinuation of cardiopulmonary bypass, the animals were recovered and monitored for 6 weeks for neurologic deficits, cognitive function (learning new skills), and organ dysfunction. Detailed examination of brains was performed at 6 weeks. Results: All the normothermic animals died, whereas survival rates for slow, medium and fast re-warming from hypothermie arrest were 50, 90, and 30%, respectively (p < 0.05 slow and medium warming versus normothermic control, p < 0.05 medium versus fast re-warming). All the surviving animals were neurologically intact, displayed normal learning capacity, and had no long-term organ dysfunction. Conclusions: Rapid induction of hypothermie arrest maintains viability of brain during repair of lethal vascular injuries. Long-term survival is influenced by the rate of reversal of hypothermia.

Original languageEnglish (US)
Pages (from-to)134-146
Number of pages13
JournalJournal of Trauma
Volume60
Issue number1
DOIs
StatePublished - Jan 2006
Externally publishedYes

Fingerprint

Rewarming
Hypothermia
Vascular System Injuries
Swine
Hemorrhage
Cardiopulmonary Bypass
Thoracic Aorta
Organ Preservation Solutions
Learning
Iliac Vein
Hyperkalemia
Lacerations
Iliac Artery
Wounds and Injuries
Brain
Thoracotomy
Neurologic Manifestations
Resuscitation
Cognition
Aorta

Keywords

  • Hypothermia
  • Neurologic function
  • Organ preservation
  • Survival
  • Suspended animation
  • Thoracotomy
  • Uncontrolled hemorrhage
  • Vascular injuries
  • Warming rate

ASJC Scopus subject areas

  • Surgery

Cite this

Does the rate of rewarming from profound hypothermic arrest influence the outcome in a swine model of lethal hemorrhage? / Alam, Hasan B.; Rhee, Peter M; Honma, Kaneatsu; Chen, Huazhen; Ayuste, Eduardo C.; Lin, Tom; Toruno, Kevin; Mehrani, Tina; Engel, Caroline; Chen, Zheng; Gentilello, Larry M.; Long, William B.; Moore, Frederick A.; Pitt, Lawrence H.; Alam, Hasan B.

In: Journal of Trauma, Vol. 60, No. 1, 01.2006, p. 134-146.

Research output: Contribution to journalArticle

Alam, HB, Rhee, PM, Honma, K, Chen, H, Ayuste, EC, Lin, T, Toruno, K, Mehrani, T, Engel, C, Chen, Z, Gentilello, LM, Long, WB, Moore, FA, Pitt, LH & Alam, HB 2006, 'Does the rate of rewarming from profound hypothermic arrest influence the outcome in a swine model of lethal hemorrhage?', Journal of Trauma, vol. 60, no. 1, pp. 134-146. https://doi.org/10.1097/01.ta.0000198469.95292.ec
Alam, Hasan B. ; Rhee, Peter M ; Honma, Kaneatsu ; Chen, Huazhen ; Ayuste, Eduardo C. ; Lin, Tom ; Toruno, Kevin ; Mehrani, Tina ; Engel, Caroline ; Chen, Zheng ; Gentilello, Larry M. ; Long, William B. ; Moore, Frederick A. ; Pitt, Lawrence H. ; Alam, Hasan B. / Does the rate of rewarming from profound hypothermic arrest influence the outcome in a swine model of lethal hemorrhage?. In: Journal of Trauma. 2006 ; Vol. 60, No. 1. pp. 134-146.
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AU - Alam, Hasan B.

AU - Rhee, Peter M

AU - Honma, Kaneatsu

AU - Chen, Huazhen

AU - Ayuste, Eduardo C.

AU - Lin, Tom

AU - Toruno, Kevin

AU - Mehrani, Tina

AU - Engel, Caroline

AU - Chen, Zheng

AU - Gentilello, Larry M.

AU - Long, William B.

AU - Moore, Frederick A.

AU - Pitt, Lawrence H.

AU - Alam, Hasan B.

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N2 - Background: Rapid induction of profound hypothermic arrest (suspended animation) can provide valuable time for the repair of complex injuries and improve survival. The optimal rate for re-warming from a state of profound hypothermia is unknown. This experiment was designed to test the impact of different warming rates on outcome in a swine model of lethal hemorrhage from complex vascular injuries. Methods: Uncontrolled lethal hemorrhage was induced in 40 swine (80-120 Ibs) by creating an iliac artery and vein injury, followed 30 minutes later (simulating transport time) by laceration of the descending thoracic aorta. Through a thoracotomy approach, a catheter was placed in the aorta and hyperkalemic organ preservation solution was infused on cardiopulmonary bypass to rapidly (2°C/min) induce profound (10°C) hypothermia. Vascular injuries were repaired during 60 minutes of hypothermic arrest. The 4 groups (n = 10/group) included normothermic controls (NC) where core temperature was maintained between 36 to 37°C, and re-warming from profound hypothermia at rates of: 0.25°C/min (slow), 0.5°C/min (medium), or 1°C/min (fast). Hyperkalemia was reversed during the hypothermic arrest period, and blood was infused for resuscitation during re-warming. After discontinuation of cardiopulmonary bypass, the animals were recovered and monitored for 6 weeks for neurologic deficits, cognitive function (learning new skills), and organ dysfunction. Detailed examination of brains was performed at 6 weeks. Results: All the normothermic animals died, whereas survival rates for slow, medium and fast re-warming from hypothermie arrest were 50, 90, and 30%, respectively (p < 0.05 slow and medium warming versus normothermic control, p < 0.05 medium versus fast re-warming). All the surviving animals were neurologically intact, displayed normal learning capacity, and had no long-term organ dysfunction. Conclusions: Rapid induction of hypothermie arrest maintains viability of brain during repair of lethal vascular injuries. Long-term survival is influenced by the rate of reversal of hypothermia.

AB - Background: Rapid induction of profound hypothermic arrest (suspended animation) can provide valuable time for the repair of complex injuries and improve survival. The optimal rate for re-warming from a state of profound hypothermia is unknown. This experiment was designed to test the impact of different warming rates on outcome in a swine model of lethal hemorrhage from complex vascular injuries. Methods: Uncontrolled lethal hemorrhage was induced in 40 swine (80-120 Ibs) by creating an iliac artery and vein injury, followed 30 minutes later (simulating transport time) by laceration of the descending thoracic aorta. Through a thoracotomy approach, a catheter was placed in the aorta and hyperkalemic organ preservation solution was infused on cardiopulmonary bypass to rapidly (2°C/min) induce profound (10°C) hypothermia. Vascular injuries were repaired during 60 minutes of hypothermic arrest. The 4 groups (n = 10/group) included normothermic controls (NC) where core temperature was maintained between 36 to 37°C, and re-warming from profound hypothermia at rates of: 0.25°C/min (slow), 0.5°C/min (medium), or 1°C/min (fast). Hyperkalemia was reversed during the hypothermic arrest period, and blood was infused for resuscitation during re-warming. After discontinuation of cardiopulmonary bypass, the animals were recovered and monitored for 6 weeks for neurologic deficits, cognitive function (learning new skills), and organ dysfunction. Detailed examination of brains was performed at 6 weeks. Results: All the normothermic animals died, whereas survival rates for slow, medium and fast re-warming from hypothermie arrest were 50, 90, and 30%, respectively (p < 0.05 slow and medium warming versus normothermic control, p < 0.05 medium versus fast re-warming). All the surviving animals were neurologically intact, displayed normal learning capacity, and had no long-term organ dysfunction. Conclusions: Rapid induction of hypothermie arrest maintains viability of brain during repair of lethal vascular injuries. Long-term survival is influenced by the rate of reversal of hypothermia.

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KW - Neurologic function

KW - Organ preservation

KW - Survival

KW - Suspended animation

KW - Thoracotomy

KW - Uncontrolled hemorrhage

KW - Vascular injuries

KW - Warming rate

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