Mild hypothermia after cardiac arrest in dogs does not affect postarrest multifocal cerebral hypoperfusion.
OBJECTIVE
Although mild resuscitative hypothermia (34 degrees C) immediately after cardiac arrest improves neurological outcome in dogs, its effects on cerebral blood flow and metabolism are unknown.


METHODS
We used stable xenon-enhanced computed tomography to study local, regional, and global cerebral blood flow patterns up to 4 hours after cardiac arrest in dogs. We compared a normothermic (37.5 degrees C) control group (group I, n = 5) with a postarrest mild hypothermic group (group II, n = 5). After ventricular fibrillation of 12.5 minutes and reperfusion with brief cardiopulmonary bypass, the ventilation, normotension, normoxia, and mild hypocapnia were controlled to 4 hours after cardiac arrest. Group II received (minimal) head cooling during cardiac arrest, followed by systemic bypass cooling (to 34 degrees C) during the first hour of reperfusion after cardiac arrest.


RESULTS
The postarrest homogeneous transient hyperemia was followed by global hypoperfusion from 1 to 4 hours after arrest, with increased "no-flow" and "trickle-flow" voxels (compared with baseline), without group differences. At 1 to 4 hours, mean global cerebral blood flow in computed tomographic slices was 55% of baseline in group I and 64% in group II (NS). No flow (local cerebral blood flow < 5 mL/100 cm3 per minute) occurred in 5 +/- 2% of the voxels in group I versus 9 +/- 5% in group II (NS). Trickle flow (5 to 10 mL/100 cm3 per minute) occurred in 10 +/- 3% voxels in group I versus 16 +/- 4% in group II (NS). Cerebral blood flow values in eight brain regions followed the same hyperemia-hypoperfusion sequence as global cerebral blood flow, with no significant difference in regional values between groups. The global cerebral metabolic rate of oxygen, which ranged between 2.7 and 4.5 mL/100 cm3 per minute before arrest in both groups, was at 1 hour after arrest 1.8 +/- 0.3 mL in normothermic group I (n = 3) and 1.9 +/- 0.4 mL is still-hypothermic group II (n = 5); at 2 and 4 hours after arrest, it ranged between 1.2 and 4.2 mL in group I and between 1.2 and 2.6 mL in group II.


CONCLUSIONS
After cardiac arrest, mild resuscitative hypothermia lasting 1 hour does not significantly affect patterns of cerebral blood flow and oxygen uptake. This suggests that different mechanisms may explain its mitigating effect on brain damage.
Oku
K
K
International Resuscitation Research Center, University of Pittsburgh, PA 15260.
Sterz
F
F
Safar
P
P
Johnson
D
D
Obrist
W
W
Leonov
Y
Y
Kuboyama
K
K
Tisherman
S A
SA
Stezoski
S W
SW
D000818:Animals; D001794:Blood Pressure; D001921:Brain / Q000098:blood supply* / Q000378:metabolism; D002560:Cerebrovascular Circulation; D004285:Dogs; D005283:Fentanyl / Q000008:administration & dosage; D006323:Heart Arrest / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D006400:Hematocrit; D007036:Hypothermia, Induced; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D009928:Organ Specificity; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D012039:Regional Blood Flow; D012151:Resuscitation / Q000379:methods
D010100:Oxygen; D005283:Fentanyl