The rate of induction of hypothermic arrest determines the outcome in a swine model of lethal hemorrhage

Hasan B. Alam, Zheng Chen, Kaneatsu Honma, Elena Koustova, Racel Ireneo Luis C. Querol, Amin Jaskille, Ryan Inocencio, Nanna Ariaban, Kevin Toruno, Amal Nadel, Peter Rhee

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Abstract

Background: Lethal injuries can be surgically repaired under asanguineous hypothermic condition (suspended animation) with excellent outcome. However, the optimal rate for the induction of hypothermic metabolic arrest following uncontrolled lethal hemorrhage (ULH) is unknown. Methods: ULH was induced in 32 female swine (80-120 lbs) by creating an iliac artery and vein injury, followed 30 minutes later by laceration of the descending thoracic aorta. Through a left thoracotomy approach, total body hypothermic hyperkalemic metabolic arrest was induced by infusing organ preservation fluids into the aorta. Experimental groups were: normothermic controls (no cooling, NC), or hypothermia induced at a rate of 0.5°C/min (slow, SC), 1°C/min (medium, MC), or 2°C/min (fast, FC). Vascular injuries were repaired during the 60 minutes of profound (10°C) hypothermic arrest. Hyperkalemia was reversed by hypokalemic fluid exchange, and blood was infused for resuscitation during the re-warming (0.5°C/ minute) period. The survivors were monitored for 6 weeks. Results: The 6 week survival rates were 0% (NC), 37.5% (SC), 62.5% (MC), and 87.5% (FC) respectively (p < 0.05 MC&FC versus NC). All of the surviving hypothermic arrest animals were neurologically intact and displayed no long term organ dysfunction. Conclusion: Hypothermic metabolic arrest can be used to maintain viability of key organs during repair of lethal injuries. Survival is influenced by the rate of cooling with the best outcome following rapid induction of hypothermia.

Original languageEnglish (US)
Pages (from-to)961-969
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume57
Issue number5
DOIs
StatePublished - Nov 1 2004

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Keywords

  • Hypothermia
  • Neurologic function
  • Organ preservation
  • Outcome
  • Suspended animation
  • Thoracotomy
  • Uncontrolled hemorrhage
  • Vascular injuries

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Alam, H. B., Chen, Z., Honma, K., Koustova, E., Querol, R. I. L. C., Jaskille, A., Inocencio, R., Ariaban, N., Toruno, K., Nadel, A., & Rhee, P. (2004). The rate of induction of hypothermic arrest determines the outcome in a swine model of lethal hemorrhage. Journal of Trauma - Injury, Infection and Critical Care, 57(5), 961-969. https://doi.org/10.1097/01.TA.0000149549.72389.3F