title: Comparison of cold crystalloid and colloid infusions for induction of therapeutic hypothermia in a porcine model of cardiac arrest.
abstract: BACKGROUND
  Large-volume cold intravenous infusion of crystalloids has been used for induction of therapeutic hypothermia after cardiac arrest. However, the effectiveness of cold colloids has not been evaluated. Therefore, we performed an experimental study to investigate the cooling effect of cold normal saline compared to colloid solution in a porcine model of ventricular fibrillation.
  
  
  METHODS
  Ventricular fibrillation was induced for 15 minutes in 22 anesthetized domestic pigs. After spontaneous circulation was restored, the animals were randomized to receive either 45 ml/kg of 1°C cold normal saline (Group A, 9 animals); or 45 ml/kg of 1°C cold colloid solution (Voluven, 6% hydroxyethyl starch 130/0.4 in 0.9% NaCl) during 20 minutes (Group B, 9 animals); or to undergo no cooling intervention (Group C, 4 animals). Then, the animals were observed for 90 minutes. Cerebral, rectal, intramuscular, pulmonary artery, and subcutaneous fat body temperatures (BT) were recorded. In the mechanical ex-vivo sub study we added a same amount of cold normal saline or colloid into the bath of normal saline and calculated the area under the curve (AUC) for induced temperature changes.
  
  
  RESULTS
  Animals treated with cold fluids achieved a significant decrease of BT at all measurement sites, whereas there was a consistent significant spontaneous increase in group C. At the time of completion of infusion, greater decrease in pulmonary artery BT and cerebral BT in group A compared to group B was detected (-2.1 ± 0.3 vs. -1.6 ± 0.2°C, and -1.7 ± 0.4 vs. -1.1 ± 0.3°C, p < 0.05, respectively). AUC analysis of the decrease of cerebral BT revealed a more vigorous cooling effect in group A compared to group B (-91 ± 22 vs. -68 ± 23°C/min, p = 0.046). In the mechanical sub study, AUC analysis of the induced temperature decrease of cooled solution revealed that addition of normal saline led to more intense cooling than colloid solution (-7155 ± 647 vs. -5733 ± 636°C/min, p = 0.008).
  
  
  CONCLUSIONS
  Intravenous infusion of cold normal saline resulted in more intense decrease of cerebral and pulmonary artery BT than colloid infusion in this porcine model of cardiac arrest. This difference is at least partially related to the various specific heat capacities of the coolants.
authors.forename: Roman
authors.initials: R
authors.lastname: Skulec
authors.forename: Anatolij
authors.initials: A
authors.lastname: Truhlar
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Turek
authors.forename: Renata
authors.initials: R
authors.lastname: Parizkova
authors.forename: Pavel
authors.initials: P
authors.lastname: Dostal
authors.forename: Shawn
authors.initials: S
authors.lastname: Hicks
authors.forename: Christian
authors.initials: C
authors.lastname: Lehmann
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cerny
mesh_terms: D000818:Animals; D000077324:Crystalloid Solutions; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000628:therapy*; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D007036:Hypothermia, Induced / Q000379:methods*; D007552:Isotonic Solutions / Q000494:pharmacology*; D011446:Prospective Studies; D011897:Random Allocation; D012965:Sodium Chloride / Q000494:pharmacology*; D013552:Swine
chemical_list: D000077324:Crystalloid Solutions; C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D012965:Sodium Chloride