title: Emergency preservation and resuscitation with profound hypothermia, oxygen, and glucose allows reliable neurological recovery after 3 h of cardiac arrest from rapid exsanguination in dogs.
abstract: We have used a rapid induction of profound hypothermia (<10 degrees C) with delayed resuscitation using cardiopulmonary bypass (CPB) as a novel approach for resuscitation from exsanguination cardiac arrest (ExCA). We have defined this approach as emergency preservation and resuscitation (EPR). We observed that 2 h but not 3 h of preservation could be achieved with favorable outcome using ice-cold normal saline flush to induce profound hypothermia. We tested the hypothesis that adding energy substrates to saline during induction of EPR would allow intact recovery after 3 h CA. Dogs underwent rapid ExCA. Two minutes after CA, EPR was induced with arterial ice-cold flush. Four treatments (n=6/group) were defined by a flush solution with or without 2.5% glucose (G+ or G-) and with either oxygen or nitrogen (O+ or O-) rapidly targeting tympanic temperature of 8 degrees C. At 3 h after CA onset, delayed resuscitation was initiated with CPB, followed by intensive care to 72 h. At 72 h, all dogs in the O+G+ group regained consciousness, and the group had better neurological deficit scores and overall performance categories than the O-groups (both P<0.05). In the O+G- group, four of the six dogs regained consciousness. All but one dog in the O-groups remained comatose. Brain histopathology in the O-G+ was worse than the other three groups (P<0.05). We conclude that EPR induced with a flush solution containing oxygen and glucose allowed satisfactory recovery of neurological function after a 3 h of CA, suggesting benefit from substrate delivery during induction or maintenance of a profound hypothermic CA.
authors.affiliation: Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA.
authors.forename: Xianren
authors.initials: X
authors.lastname: Wu
authors.forename: Tomas
authors.initials: T
authors.lastname: Drabek
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Tisherman
authors.forename: Jeremy
authors.initials: J
authors.lastname: Henchir
authors.forename: S William
authors.initials: SW
authors.lastname: Stezoski
authors.forename: Sherman
authors.initials: S
authors.lastname: Culver
authors.forename: Jason
authors.initials: J
authors.lastname: Stezoski
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Jackson
authors.forename: Robert
authors.initials: R
authors.lastname: Garman
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kochanek
mesh_terms: D000818:Animals; D001831:Body Temperature / Q000502:physiology; D001921:Brain / Q000473:pathology; D002315:Cardiopulmonary Bypass; D016887:Cardiopulmonary Resuscitation; D003243:Consciousness / Q000502:physiology; D003422:Critical Care; D004285:Dogs; D004632:Emergency Medical Services; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy*; D007036:Hypothermia, Induced; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D010100:Oxygen / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005947:Glucose; D010100:Oxygen