title: Active internal re-warming using a centrifugal pump and heat exchanger following haemorrhagic shock, surgical trauma and hypothermia in a porcine model.
abstract: BACKGROUND
  The centrifugal vortex blood pump (CVBP) using heparin-bonded circuitry allows re-warming of hypothermic trauma patients without anticoagulation. Study objectives were to confirm efficacy, and to characterise the physiology of CVBP re-warming in a porcine model.
  
  
  METHODS
  Sixteen pigs were randomised to conventional or CVBP re-warming. They were bled to a mean arterial pressure of 30 mmHg and cooled to 29 degrees C. A physiological analysis was recorded during resuscitation to normo-tension and re-warming back to 37 degrees C.
  
  
  RESULTS
  CVBP animals re-warmed significantly faster: 85.0+16.4 min versus 217.4+49.3 min (p<0.0001). Activated clotting time was significantly elevated in both groups at 29 degrees C with a marked trend to normalise faster in CVBP pigs. The peak cardiac index (CI) was significantly lower (1.14+0.68 versus 4.83+1.50 L/(min m2), while the systemic vascular resistance (SVR) was significantly higher (4239.9+1173.0 versus 1472.6+451.2 dyn x S x m2/cm5) with CVBP (p<0.001).
  
  
  CONCLUSIONS
  CVBP is simple and very effective at re-warming hypothermic animals and may also reverse coagulopathy more quickly. Physiological derangements of elevated SVR and diminished CI require further study to elaborate underlying aetiology, and define optimal re-warming strategies.
authors.affiliation: Section of Trauma, Division of General Surgery, University of British Columbia, Vancouver, BC, Canada. garraway@telus.net
authors.forename: Naisan
authors.initials: N
authors.lastname: Garraway
authors.forename: D Ross
authors.initials: DR
authors.lastname: Brown
authors.forename: David
authors.initials: D
authors.lastname: Nash
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirkpatrick
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Schneidereit
authors.forename: Rardi
authors.initials: R
authors.lastname: Van Heest
authors.forename: Hamish
authors.initials: H
authors.lastname: Hwang
authors.forename: Richard
authors.initials: R
authors.lastname: Simons
mesh_terms: D000818:Animals; D001831:Body Temperature / Q000502:physiology*; D005260:Female; D007035:Hypothermia / Q000628:therapy*; D023421:Models, Animal; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods; D017694:Rewarming / Q000295:instrumentation* / Q000379:methods; D012771:Shock, Hemorrhagic / Q000628:therapy*; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*