title: Whole body hyperthermia by extracorporeal circulation in spontaneously breathing sarcoma patients: hemodynamics and oxygen metabolism.
abstract: OBJECTIVE
  This phase I study was performed to evaluate the feasibility and toxicity of a new method of extracorporeal perfusion-induced whole body hyperthermia (WBHT) in patients with advanced sarcoma avoiding the need of intubation and general anesthesia.
  
  
  METHODS
  One double-lumen femoral venous access was inserted by Seldinger's technique to obtain WBHT (41.8°C for 120 minutes) via an extracorporeal circuit. No concomitant chemotherapy was applied. Up to 4 treatments of WBHT were performed under moderate sedation in 6 spontaneously breathing patients. Invasive hemodynamic monitoring was performed by use of a pulmonary artery catheter.
  
  
  RESULTS
  After their first WBHT session, 2 patients were excluded from further treatment due to transient liver toxicity or catheter-related complication, so a total of 12 cycles remained for analyses. In all patients, conscious sedation resulted in sufficient spontaneous respiration without the need for mandatory ventilation. Median time to reach the target temperature was 84 minutes (range 60-142). Hemodynamic changes revealed the expected hyperdynamic state: heart rate, cardiac index, and stroke volume index significantly increased (p<0.05), whereas blood pressure and systemic and pulmonary vascular resistance index significantly decreased (p<0.05). A net fluid balance of 5822±1766 mL as well as norepinephrine (mean; 0.062 µg·kg¹·min⁻¹) were necessary to maintain the mean arterial blood pressure >60 mmHg.
  
  
  CONCLUSIONS
  Our data demonstrate the feasibility of this method of extracorporeal WBHT without mandatory ventilation. Hemodynamic side effects in spontaneously breathing patients during perfusion-induced WBHT seem less severe than those observed in radiant heat WBHT.
authors.affiliation: Intensive Care Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria. gottfried.locker@meduniwien.ac.at
authors.forename: Gottfried J
authors.initials: GJ
authors.lastname: Locker
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Fuchs
authors.forename: Nina
authors.initials: N
authors.lastname: Worel
authors.forename: Andja
authors.initials: A
authors.lastname: Bojic
authors.forename: Gerhard
authors.initials: G
authors.lastname: Heinrich
authors.forename: Thomas
authors.initials: T
authors.lastname: Brodowicz
authors.forename: Martin
authors.initials: M
authors.lastname: Clodi
authors.forename: Georg-Christian
authors.initials: GC
authors.lastname: Funk
authors.forename: Paul
authors.initials: P
authors.lastname: Knöbl
authors.forename: Christoph C
authors.initials: CC
authors.lastname: Zielinski
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Köstler
mesh_terms: D000328:Adult; D001317:Austria; D002407:Catheterization, Swan-Ganz; D016292:Procedural Sedation; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein; D006439:Hemodynamics; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D008168:Lung / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D015656:Respiratory Mechanics; D012509:Sarcoma / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010100:Oxygen