Differential expression of neuronal fos protein after cold water drowning and controlled rewarming.
BACKGROUND
Cardiopulmonary bypass has often been applied to revive victims of cold water drowning. The success of resuscitative efforts in patients who have sustained severe hypothermia is largely determined by neurologic outcomes. Measurement of Fos, the protein product of the immediate-early gene c-fos, is a marker of cerebral injury.


METHODS
Twenty-eight infant lambs were sedated and ventilated. Group 1 lambs were immersed in a cold water bath for 2 hours (17.3 +/- 2.7 degrees C). Group 2 lambs were placed on normothermic cardiopulmonary bypass for 2 hours (37.7 degrees +/- 0.7 degrees C). Group 3 lambs were immersed in a cold water bath for 2 hours (17.6 degrees +/- 2.4 degrees C), and then rewarmed for a period of 2 hours on cardiopulmonary bypass (37.0 degrees +/- 0.6 degrees C). The lambs were euthanized and immunohistochemical analysis for neuronal Fos was performed.


RESULTS
There was significant induction of Fos-labeled nuclear profiles (cells/1130 microm(2)) in group 3 in the hippocampal regions and dentate gyrus compared with groups 1 and 2 (p < 0.001).


CONCLUSIONS
Isolated exposure to either hypothermia or cardiopulmonary bypass results in minimal expression of neuronal Fos; the significant induction of Fos in the group 3 animals may represent an ischemic-reperfusion phenomenon. Modifications of rewarming techniques that minimize Fos expression may improve neurologic outcomes in victims of cold water drowning.
Robinson
Davida A
DA
Division of Cardiothoracic Surgery, Tufts-New England Medical Center, Boston, MA 02111, USA.
O'Brien
Patrick K H
PK
Gheewala
Raeeda M
RM
Nikulina
Ella M
EM
Payne
Douglas D
DD
Hammer
Ronald P
RP
Warner
Kenneth G
KG
D000818:Animals; D000831:Animals, Newborn; D001925:Brain Damage, Chronic / Q000473:pathology*; D002315:Cardiopulmonary Bypass; D016923:Cell Death / Q000502:physiology; D018891:Dentate Gyrus / Q000473:pathology; D004332:Drowning / Q000473:pathology*; D006624:Hippocampus / Q000473:pathology; D007035:Hypothermia / Q000473:pathology*; D009474:Neurons / Q000473:pathology; D016760:Proto-Oncogene Proteins c-fos / Q000032:analysis*; D015427:Reperfusion Injury / Q000473:pathology*; D017694:Rewarming; D012756:Sheep
D016760:Proto-Oncogene Proteins c-fos