High-flow venovenous rewarming for the correction of hypothermia in a canine model of hypovolemic shock.
BACKGROUND
Continuous arteriovenous rewarming (CAVR) has been shown to effectively reverse hypothermia; however, its use is limited in the setting of profound hypotension. We have evaluated the effectiveness of high-flow venovenous rewarming (HFVR) using bypass for the correction of hypothermia in a hypotensive canine model and compared these results to CAVR.


METHODS
Eight dogs, randomly assigned to either HFVR or CAVR, were cooled to a core temperature of 29.5 degrees C and then bled to a mean arterial pressure of 55 mm Hg. Rewarming was then initiated and the time required for blood, liver parenchyma, and esophageal (core) temperature to reach 36 degrees C was recorded.


RESULTS
Mean flow rates were 1,536 +/- 667 mL/min for HFVR and 196 +/- 35 mL/min for CAVR (p = 0.007). Time in minutes to rewarm to 36 degrees C for the HFVR versus the CAVR groups, respectively, were as follows: blood, 12 +/- 2 versus 99 +/- 19; liver, 21 +/- 3 versus 102 +/- 16; and esophageal, 25 +/- 6 versus 125 +/- 17 (all < 0.001).


CONCLUSIONS
HFVR is an effective method for rapid rewarming in a profoundly hypothermic, hypotensive animal model and may have clinical utility in patients presenting with hypovolemia/hypotension complicated by hypothermia.
Janczyk
Randy J
RJ
Division of Trauma Surgery, Department of General Surgery, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Park
David Y
DY
Howells
Greg A
GA
Bair
Holly A
HA
Jonik
Ann Marie
AM
McFall
Roberta E
RE
Bendick
Phillip J
PJ
Gentilello
Larry M
LM
D000818:Animals; D001831:Body Temperature; D004285:Dogs; D006400:Hematocrit; D006439:Hemodynamics; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods*; D006454:Hemoglobins / Q000032:analysis; D007035:Hypothermia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012769:Shock / Q000150:complications* / Q000503:physiopathology / Q000628:therapy
D006454:Hemoglobins