Mild hypothermia delays the development of stone heart from untreated sustained ventricular fibrillation - A cardiovascular magnetic resonance study

Vincent L. Sorrell, Vijayasree Paleru, Maria I Altbach, Ronald W. Hilwig, Karl B Kern, Mohamed Gaballa, Gordon A. Ewy, Robert A. Berg

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Abstract

Background: 'Stone heart' resulting from ischemic contracture of the myocardium, precludes successful resuscitation from ventricular fibrillation (VF). We hypothesized that mild hypothermia might slow the progression to stone heart. Methods. Fourteen swine (27 1 kg) were randomized to normothermia (group I; n = 6) or hypothermia groups (group II; n = 8). Mild hypothermia (34 2°C) was induced with ice packs prior to VF induction. The LV and right ventricular (RV) cross-sectional areas were followed by cardiovascular magnetic resonance until the development of stone heart. A commercial 1.5T GE Signa NV-CV/i scanner was used. Complete anatomic coverage of the heart was acquired using a steady-state free precession (SSFP) pulse sequence gated at baseline prior to VF onset. Un-gated SSFP images were obtained serially after VF induction. The ventricular endocardium was manually traced and LV and RV volumes were calculated at each time point. Results: In group I, the LV was dilated compared to baseline at 5 minutes after VF and this remained for 20 minutes. Stone heart, arbitrarily defined as LV volume <1/3 of baseline at the onset of VF, occurred at 29 3 minutes. In group II, there was less early dilation of the LV (p < 0.05) and the development of stone heart was delayed to 52 4 minutes after onset of VF (P < 0.001). Conclusions: In this closed-chest swine model of prolonged untreated VF, hypothermia reduced the early LV dilatation and importantly, delayed the onset of stone heart thereby extending a known, morphologic limit of resuscitability.

Original languageEnglish (US)
Article number17
JournalJournal of Cardiovascular Magnetic Resonance
Volume13
Issue number1
DOIs
StatePublished - 2011

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Ventricular Fibrillation
Hypothermia
Magnetic Resonance Spectroscopy
Dilatation
Swine
Ischemic Contracture
Endocardium
Ice
Resuscitation
Myocardium
Thorax

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Family Practice
  • Medicine(all)

Cite this

Mild hypothermia delays the development of stone heart from untreated sustained ventricular fibrillation - A cardiovascular magnetic resonance study. / Sorrell, Vincent L.; Paleru, Vijayasree; Altbach, Maria I; Hilwig, Ronald W.; Kern, Karl B; Gaballa, Mohamed; Ewy, Gordon A.; Berg, Robert A.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 13, No. 1, 17, 2011.

Research output: Contribution to journalArticle

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AU - Kern, Karl B

AU - Gaballa, Mohamed

AU - Ewy, Gordon A.

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N2 - Background: 'Stone heart' resulting from ischemic contracture of the myocardium, precludes successful resuscitation from ventricular fibrillation (VF). We hypothesized that mild hypothermia might slow the progression to stone heart. Methods. Fourteen swine (27 1 kg) were randomized to normothermia (group I; n = 6) or hypothermia groups (group II; n = 8). Mild hypothermia (34 2°C) was induced with ice packs prior to VF induction. The LV and right ventricular (RV) cross-sectional areas were followed by cardiovascular magnetic resonance until the development of stone heart. A commercial 1.5T GE Signa NV-CV/i scanner was used. Complete anatomic coverage of the heart was acquired using a steady-state free precession (SSFP) pulse sequence gated at baseline prior to VF onset. Un-gated SSFP images were obtained serially after VF induction. The ventricular endocardium was manually traced and LV and RV volumes were calculated at each time point. Results: In group I, the LV was dilated compared to baseline at 5 minutes after VF and this remained for 20 minutes. Stone heart, arbitrarily defined as LV volume <1/3 of baseline at the onset of VF, occurred at 29 3 minutes. In group II, there was less early dilation of the LV (p < 0.05) and the development of stone heart was delayed to 52 4 minutes after onset of VF (P < 0.001). Conclusions: In this closed-chest swine model of prolonged untreated VF, hypothermia reduced the early LV dilatation and importantly, delayed the onset of stone heart thereby extending a known, morphologic limit of resuscitability.

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