Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model

Karl B Kern, Joseph M. Hanna, Hayley N. Young, Carl J. Ellingson, Joshua J. White, Brian Heller, Uday Illindala, Chiu-Hsieh Hsu, Mathias Zuercher

Research output: Contribution to journalArticle

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Abstract

Objectives The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest. Background Cohort studies have shown that 1 in 4 post–cardiac arrest patients without ST-segment elevation has an acutely occluded coronary artery. However, many interventional cardiologists remain unconvinced that immediate coronary angiography is needed in these patients. Methods Thirty-two swine (mean weight 35 ± 5 kg) were randomly assigned to 1 of the following 4 treatment groups: group A, hypothermia and reperfusion; group B, hypothermia and no reperfusion; group C, no hypothermia and reperfusion; and group D, no hypothermia and no reperfusion. The left anterior descending coronary artery was occluded with an intracoronary balloon, and ventricular fibrillation was electrically induced. Cardiopulmonary resuscitation was begun after 4 min of cardiac arrest. Defibrillation was attempted after 2 min of cardiopulmonary resuscitation. Resuscitated animals randomized to hypothermia were rapidly cooled to 34°C, whereas those randomized to reperfusion had such after 45 min of left anterior descending coronary artery occlusion. Results At 4 h, myocardial infarct size was calculated. Group A had the smallest infarct size at 16.1 ± 19.6% (p < 0.05). Group C had an intermediate infarct size at 29.5 ± 20.2%, whereas groups B and D had the largest infarct sizes at 41.5 ± 15.5% and 41.1 ± 15.0%, respectively. Conclusions Acute coronary occlusion is often associated with cardiac arrest, so treatment of resuscitated patients should include early coronary angiography for potential emergent reperfusion, while providing hypothermia for both brain and myocardial protection. Providing only early hypothermia, while delaying coronary angiography, is not optimal.

Original languageEnglish (US)
Pages (from-to)2403-2412
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume9
Issue number23
DOIs
StatePublished - Dec 12 2016

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Hypothermia
Reperfusion
Swine
Heart Arrest
Coronary Angiography
Coronary Vessels
Coronary Occlusion
Cardiopulmonary Resuscitation
Ventricular Fibrillation
Cohort Studies
Myocardial Infarction
Weights and Measures
Brain
Therapeutics

Keywords

  • cardiac arrest
  • coronary angiography
  • hypothermia
  • myocardial infarction
  • reperfusion
  • resuscitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model. / Kern, Karl B; Hanna, Joseph M.; Young, Hayley N.; Ellingson, Carl J.; White, Joshua J.; Heller, Brian; Illindala, Uday; Hsu, Chiu-Hsieh; Zuercher, Mathias.

In: JACC: Cardiovascular Interventions, Vol. 9, No. 23, 12.12.2016, p. 2403-2412.

Research output: Contribution to journalArticle

Kern, Karl B ; Hanna, Joseph M. ; Young, Hayley N. ; Ellingson, Carl J. ; White, Joshua J. ; Heller, Brian ; Illindala, Uday ; Hsu, Chiu-Hsieh ; Zuercher, Mathias. / Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model. In: JACC: Cardiovascular Interventions. 2016 ; Vol. 9, No. 23. pp. 2403-2412.
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abstract = "Objectives The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest. Background Cohort studies have shown that 1 in 4 post–cardiac arrest patients without ST-segment elevation has an acutely occluded coronary artery. However, many interventional cardiologists remain unconvinced that immediate coronary angiography is needed in these patients. Methods Thirty-two swine (mean weight 35 ± 5 kg) were randomly assigned to 1 of the following 4 treatment groups: group A, hypothermia and reperfusion; group B, hypothermia and no reperfusion; group C, no hypothermia and reperfusion; and group D, no hypothermia and no reperfusion. The left anterior descending coronary artery was occluded with an intracoronary balloon, and ventricular fibrillation was electrically induced. Cardiopulmonary resuscitation was begun after 4 min of cardiac arrest. Defibrillation was attempted after 2 min of cardiopulmonary resuscitation. Resuscitated animals randomized to hypothermia were rapidly cooled to 34°C, whereas those randomized to reperfusion had such after 45 min of left anterior descending coronary artery occlusion. Results At 4 h, myocardial infarct size was calculated. Group A had the smallest infarct size at 16.1 ± 19.6{\%} (p < 0.05). Group C had an intermediate infarct size at 29.5 ± 20.2{\%}, whereas groups B and D had the largest infarct sizes at 41.5 ± 15.5{\%} and 41.1 ± 15.0{\%}, respectively. Conclusions Acute coronary occlusion is often associated with cardiac arrest, so treatment of resuscitated patients should include early coronary angiography for potential emergent reperfusion, while providing hypothermia for both brain and myocardial protection. Providing only early hypothermia, while delaying coronary angiography, is not optimal.",
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AU - Kern, Karl B

AU - Hanna, Joseph M.

AU - Young, Hayley N.

AU - Ellingson, Carl J.

AU - White, Joshua J.

AU - Heller, Brian

AU - Illindala, Uday

AU - Hsu, Chiu-Hsieh

AU - Zuercher, Mathias

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N2 - Objectives The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest. Background Cohort studies have shown that 1 in 4 post–cardiac arrest patients without ST-segment elevation has an acutely occluded coronary artery. However, many interventional cardiologists remain unconvinced that immediate coronary angiography is needed in these patients. Methods Thirty-two swine (mean weight 35 ± 5 kg) were randomly assigned to 1 of the following 4 treatment groups: group A, hypothermia and reperfusion; group B, hypothermia and no reperfusion; group C, no hypothermia and reperfusion; and group D, no hypothermia and no reperfusion. The left anterior descending coronary artery was occluded with an intracoronary balloon, and ventricular fibrillation was electrically induced. Cardiopulmonary resuscitation was begun after 4 min of cardiac arrest. Defibrillation was attempted after 2 min of cardiopulmonary resuscitation. Resuscitated animals randomized to hypothermia were rapidly cooled to 34°C, whereas those randomized to reperfusion had such after 45 min of left anterior descending coronary artery occlusion. Results At 4 h, myocardial infarct size was calculated. Group A had the smallest infarct size at 16.1 ± 19.6% (p < 0.05). Group C had an intermediate infarct size at 29.5 ± 20.2%, whereas groups B and D had the largest infarct sizes at 41.5 ± 15.5% and 41.1 ± 15.0%, respectively. Conclusions Acute coronary occlusion is often associated with cardiac arrest, so treatment of resuscitated patients should include early coronary angiography for potential emergent reperfusion, while providing hypothermia for both brain and myocardial protection. Providing only early hypothermia, while delaying coronary angiography, is not optimal.

AB - Objectives The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest. Background Cohort studies have shown that 1 in 4 post–cardiac arrest patients without ST-segment elevation has an acutely occluded coronary artery. However, many interventional cardiologists remain unconvinced that immediate coronary angiography is needed in these patients. Methods Thirty-two swine (mean weight 35 ± 5 kg) were randomly assigned to 1 of the following 4 treatment groups: group A, hypothermia and reperfusion; group B, hypothermia and no reperfusion; group C, no hypothermia and reperfusion; and group D, no hypothermia and no reperfusion. The left anterior descending coronary artery was occluded with an intracoronary balloon, and ventricular fibrillation was electrically induced. Cardiopulmonary resuscitation was begun after 4 min of cardiac arrest. Defibrillation was attempted after 2 min of cardiopulmonary resuscitation. Resuscitated animals randomized to hypothermia were rapidly cooled to 34°C, whereas those randomized to reperfusion had such after 45 min of left anterior descending coronary artery occlusion. Results At 4 h, myocardial infarct size was calculated. Group A had the smallest infarct size at 16.1 ± 19.6% (p < 0.05). Group C had an intermediate infarct size at 29.5 ± 20.2%, whereas groups B and D had the largest infarct sizes at 41.5 ± 15.5% and 41.1 ± 15.0%, respectively. Conclusions Acute coronary occlusion is often associated with cardiac arrest, so treatment of resuscitated patients should include early coronary angiography for potential emergent reperfusion, while providing hypothermia for both brain and myocardial protection. Providing only early hypothermia, while delaying coronary angiography, is not optimal.

KW - cardiac arrest

KW - coronary angiography

KW - hypothermia

KW - myocardial infarction

KW - reperfusion

KW - resuscitation

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