Topical head cooling during rewarming after experimental hypothermic circulatory arrest.
BACKGROUND
The aim of this study was to evaluate the potential neuroprotective effect of topical head cooling during the first 2 postoperative hours after experimental hypothermic circulatory arrest.


METHODS
Twenty pigs underwent a 75-minute period of hypothermic circulatory arrest and were randomly assigned to rewarming to 37 degrees C or to undergo topical cooling of the head for 2 hours from the start of rewarming followed by a period of external rewarming to 37 degrees C.


RESULTS
The 7-day survival rate was 70% in the control group and 60% in the topical head cooling group. Despite brain tissue oxygenation, intracranial pressures, mixed oxygen venous saturation, oxygen consumption, and extraction tended to be favorable in the topical head cooling group as a clear effect of mild hypothermia. The latter group had significantly higher postoperative brain lactate and pyruvate ratios, and lactate and glucose ratios. Furthermore, the topical head cooling group had worse fluid balance throughout the postoperative period. Brain histopathologic scores were comparable with the study groups, but among 7-days survivors these scores tended to be worse in the topical head cooling group.


CONCLUSIONS
Topical cooling of the head during the first 2 postoperative hours after experimental hypothermic circulatory arrest does not appear to provide any neuroprotective effect.
Pokela
Matti
M
Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland.
Heikkinen
Janne
J
Biancari
Fausto
F
Rönkä
Erkka
E
Kaakinen
Timo
T
Vainionpää
Vilho
V
Kiviluoma
Kai T
KT
Romsi
Pekka
P
Leo
Enrico
E
Hirvonen
Jorma
J
Lepola
Pasi
P
Rimpiläinen
Jussi
J
Juvonen
Tatu S
TS
D000818:Animals; D001921:Brain / Q000098:blood supply* / Q000473:pathology; D002545:Brain Ischemia / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D007036:Hypothermia, Induced / Q000379:methods*; D015427:Reperfusion Injury / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D017694:Rewarming / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D013552:Swine