title: A pilot study of mechanical stimulation and cardiac dysrhythmias in a porcine model of induced hypothermia.
abstract: BACKGROUND
  Hypothermia is a frequent complication of cold weather exposure and/or wilderness injuries. Anecdotal reports have postulated that patients suffering from acute hypothermia are at significantly increased risk of developing lethal cardiac dysrhythmias secondary to the physical stimulation from moving and transporting patients.
  
  
  OBJECTIVE
  To develop a model to attempt to determine if rough handling and sudden movement can induce lethal cardiac dysrhythmias in a controlled animal study of mild to severe hypothermia.
  
  
  METHODS
  Ten anesthetized swine had continuous cardiac and invasive blood pressure (BP) monitoring. Core body temperature (CBT) was measured with an esophageal probe. Animals were secured to a backboard in a supine position for the duration of the study and their CBT was serially lowered by external cooling measures. At preset intervals (every 3 degrees C lowered from the baseline CBT of 38 degrees C), the animals were lifted via the backboard and rolled 90 degrees to the left and held for 5 seconds and then rolled to the right and held for 5 seconds. After rolling, the swine were lifted via the backboard 6 inches off the surgical table and dropped back onto the table, and after 15 seconds this was repeated at 12 inches. If no signs of dysrhythmia were noted, external cooling was continued. Data were analyzed by tests of proportion on mortality associated with hypothermia and mechanical stimulation. To determine whether hypothermia and mechanical stimulation were independent effects, a one-sided McNemar's test of matched pairs was employed.
  
  
  RESULTS
  No animal developed a dysrhythmia at a CBT > 25 degrees C with or without stimulation. Fifty percent of the animals developed fatal dysrhythmias (3 ventricular fibrillation, 2 asystole) with no stimulation but at CBT <or= 25 degrees C (average CBT 22.7 degrees C). Twenty percent (2/10) developed fatal dysrhythmias (ventricular fibrillation) during mechanical stimulation. For hypothermia, a binomial test of the observed proportion 0.70 (fatality during hypothermia) against a hypothetical proportion of 0 (no fatality in the absence of hypothermia) yielded P < .001 with power = 1.00. For mechanical stimulation, a binomial test of the observed proportion 0.20 (fatality from mechanical stimulation); against a hypothetical proportion of 0 yielded P < .001 with power = 1.00. The test of matched pairs yielded P < .037, indicating that the variables of mechanical stimulation and hypothermia jointly caused mortality.
  
  
  CONCLUSIONS
  Profound hypothermia induces fatal dysrhythmias both with and without mechanical stimulation in a swine model.
authors.affiliation: Department of Emergency Medicine, Naval Medical Center, San Diego, CA 92134-5000, USA.
authors.forename: James
authors.initials: J
authors.lastname: Grueskin
authors.forename: David A
authors.initials: DA
authors.lastname: Tanen
authors.forename: Pamela
authors.initials: P
authors.lastname: Harvey
authors.forename: Frank
authors.initials: F
authors.lastname: Dos Santos
authors.forename: William H
authors.initials: WH
authors.lastname: Richardson
authors.forename: Robert H
authors.initials: RH
authors.lastname: Riffenburgh
mesh_terms: D000818:Animals; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology; D001831:Body Temperature / Q000502:physiology*; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology; D007036:Hypothermia, Induced / Q000009:adverse effects*; D010865:Pilot Projects; D011897:Random Allocation; D013552:Swine