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 M Rhee

Research output: Contribution to journalArticle

47 Citations (Scopus)

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
Volume57
Issue number5
DOIs
StatePublished - Nov 2004
Externally publishedYes

Fingerprint

Swine
Hemorrhage
Thoracic Aorta
Wounds and Injuries
Organ Preservation
Iliac Vein
Induced Hypothermia
Tissue Survival
Hyperkalemia
Lacerations
Iliac Artery
Vascular System Injuries
Thoracotomy
Hypothermia
Resuscitation
Aorta

Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

The rate of induction of hypothermic arrest determines the outcome in a swine model of lethal hemorrhage. / Alam, Hasan B.; Chen, Zheng; Honma, Kaneatsu; Koustova, Elena; Querol, Racel Ireneo Luis C; Jaskille, Amin; Inocencio, Ryan; Ariaban, Nanna; Toruno, Kevin; Nadel, Amal; Rhee, Peter M.

In: Journal of Trauma, Vol. 57, No. 5, 11.2004, p. 961-969.

Research output: Contribution to journalArticle

Alam, HB, Chen, Z, Honma, K, Koustova, E, Querol, RILC, Jaskille, A, Inocencio, R, Ariaban, N, Toruno, K, Nadel, A & Rhee, PM 2004, 'The rate of induction of hypothermic arrest determines the outcome in a swine model of lethal hemorrhage', Journal of Trauma, vol. 57, no. 5, pp. 961-969. https://doi.org/10.1097/01.TA.0000149549.72389.3F
Alam, Hasan B. ; Chen, Zheng ; Honma, Kaneatsu ; Koustova, Elena ; Querol, Racel Ireneo Luis C ; Jaskille, Amin ; Inocencio, Ryan ; Ariaban, Nanna ; Toruno, Kevin ; Nadel, Amal ; Rhee, Peter M. / The rate of induction of hypothermic arrest determines the outcome in a swine model of lethal hemorrhage. In: Journal of Trauma. 2004 ; Vol. 57, No. 5. pp. 961-969.
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T1 - The rate of induction of hypothermic arrest determines the outcome in a swine model of lethal hemorrhage

AU - Alam, Hasan B.

AU - Chen, Zheng

AU - Honma, Kaneatsu

AU - Koustova, Elena

AU - Querol, Racel Ireneo Luis C

AU - Jaskille, Amin

AU - Inocencio, Ryan

AU - Ariaban, Nanna

AU - Toruno, Kevin

AU - Nadel, Amal

AU - Rhee, Peter M

PY - 2004/11

Y1 - 2004/11

N2 - 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.

AB - 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.

KW - Hypothermia

KW - Neurologic function

KW - Organ preservation

KW - Outcome

KW - Suspended animation

KW - Thoracotomy

KW - Uncontrolled hemorrhage

KW - Vascular injuries

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