Effects of Mild Hypothermia on Cerebral Large and Small Microvessels Blood Flow in a Porcine Model of Cardiac Arrest
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TRANSLATIONAL RESEARCH
Effects of Mild Hypothermia on Cerebral Large and Small Microvessels Blood Flow in a Porcine Model of Cardiac Arrest Junyuan Wu1 • Wei Yuan1 • Jiebin Li2 • Yongzhen Zhao1 • Jie Li3 Zhenhua Li4 • Chunsheng Li1
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Ó Springer Science+Business Media New York 2017
Abstract Background The effect of mild hypothermia (MH) on microcirculation after resuscitation from cardiac arrest is controversial. The aim of this study was to determine whether MH improves or aggravates the disturbance of cerebral microcirculation. Methods Twenty domestic male pigs were randomized into the MH group (n = 8), non-hypothermia (NH) group (n = 8) or sham operation group (n = 4). In the MH group, the animals were initiated rapid intravascular cooling at 1 h after return of spontaneous circulation (ROSC) from 8 min ventricular fibrillation, and the core temperature was reduced to 33 °C for 12 h and then rewarmed to 37 °C. In the NH group, animals did not receive hypothermia treatment after ROSC. In the sham operation group, the same surgical procedure was performed, but without inducing ventricular fibrillation and hypothermia treatment. The cerebral microvascular flow index (MFI) of large microvessel (diameter > 20 lm) and
Electronic supplementary material The online version of this article (doi:10.1007/s12028-017-0395-6) contains supplementary material, which is available to authorized users. & Chunsheng Li [email protected] 1
Beijing Key Laboratory of Cardiopulmonary-Cerebral Resuscitation, Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China
2
Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
3
Department of Emergency Medicine, Beijing Fuxing Hospital, Capital Medical University, Beijing 100038, China
4
Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
small microvessel (diameter < 20 lm) was measured after ROSC. Cerebral oxygen extraction ratio, internal jugular venous–artery lactate difference, and CO2 difference were also calculated. Results Cerebral MFI dramatically reduced after ROSC, and MH further aggravated the decrease in MFI of small microvessel compared with NH (p < 0.05). Internal jugular venous-arterial lactate difference and CO2 difference, and oxygen extraction ratio were all significantly increased after ROSC. MH significantly decreased the values compared with NH (p < 0.05). Conclusions MH decreases cerebral small microvessel blood flow and cerebral metabolism after ROSC compared with NH. However, the total effect is that cerebral oxygen supply–demand relationship is improved during hypothermia. Keywords Cardiac arrest Mild hypothermia Cerebral metabolism Cerebral microcirculation Lactate Animal models
Introduction Sudden cardiac arrest (CA) is one of the leading causes of death in the world [1]. Although cardiopulmonary resuscitation (CPR) techniques continue to improve for decades, average survival
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