title: Hypothermic liquid ventilation prevents early hemodynamic dysfunction and cardiovascular mortality after coronary artery occlusion complicated by cardiac arrest in rabbits.
abstract: OBJECTIVE
  Ultrafast and whole-body cooling can be induced by total liquid ventilation with temperature-controlled perfluorocarbons. Our goal was to determine whether this can afford maximal cardio- and neuroprotections through cooling rapidity when coronary occlusion is complicated by cardiac arrest.
  
  
  METHODS
  Prospective, randomized animal study.
  
  
  METHODS
  Academic research laboratory.
  
  
  METHODS
  Male New Zealand rabbits.
  
  
  METHODS
  Chronically instrumented rabbits were submitted to coronary artery occlusion and ventricular fibrillation. After 8 minutes of cardiac arrest, animals were resuscitated and submitted to a normothermic follow-up (control group) or to 3 hours of mild hypothermia induced by total liquid ventilation (total liquid ventilation group) or by combination of cold saline infusion and cold blankets application (saline group). Coronary reperfusion was permitted 40 minutes after the onset of occlusion. After awakening, rabbits were followed up during 7 days.
  
  
  RESULTS
  Ten animals were resuscitated in each group. In the control group, all animals secondarily died of cardiac/respiratory failure (8 of 10) or neurological dysfunction (2 of 10). In the saline group, the target temperature of 32°C was achieved within 30-45 minutes after cooling initiation. This slightly reduced infarct size versus control (41% ± 16% vs 54% ± 8% of risk zone, respectively; p < 0.05) but failed to significantly improve cardiac output, neurological recovery, and survival rate (three survivors, six death from cardiac/respiratory failure, and one from neurological dysfunction). Conversely, the 32°C temperature was achieved within 5-10 minutes in the total liquid ventilation group. This led to a dramatic reduction in infarct size (13% ± 4%; p < 0.05 vs other groups) and improvements in cardiac output, neurological recovery, and survival (eight survivors, two deaths from cardiac/respiratory failure).
  
  
  CONCLUSIONS
  Achieving hypothermia rapidly is critical to improve the cardiovascular outcome after cardiac arrest with underlying myocardial infarction.
authors.affiliation: 1INSERM, U955, Equipe 3, Créteil, France. 2Université Paris-Est, UMR_S955, UPEC, Créteil, France. 3Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France. 4Assistance Publique, Hôpitaux de Paris, Hôpital du Kremlin-Bicêtre, Service d'Anatomie Pathologique, Le Kremlin-Bicêtre, France. 5INSERM, U970, Paris, France. 6SAMU de Paris, Département d'Anesthésie Réanimation, CHU Necker Enfants Malades, Université Paris Descartes-Paris V, Paris, France. 7INSERM, U722, UFR de Médecine Paris Diderot, Paris, France. 8Assistance Publique, Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-chirurgicale, Colombes, France.
authors.forename: Lys
authors.initials: L
authors.lastname: Darbera
authors.forename: Mourad
authors.initials: M
authors.lastname: Chenoune
authors.forename: Fanny
authors.initials: F
authors.lastname: Lidouren
authors.forename: Matthias
authors.initials: M
authors.lastname: Kohlhauer
authors.forename: Clovis
authors.initials: C
authors.lastname: Adam
authors.forename: Patrick
authors.initials: P
authors.lastname: Bruneval
authors.forename: Bijan
authors.initials: B
authors.lastname: Ghaleh
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Randé
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
authors.forename: Benoit
authors.initials: B
authors.lastname: Vivien
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.forename: Alain
authors.initials: A
authors.lastname: Berdeaux
authors.forename: Renaud
authors.initials: R
authors.lastname: Tissier
mesh_terms: D000818:Animals; D002302:Cardiac Output; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D054059:Coronary Occlusion / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D007036:Hypothermia, Induced; D021061:Liquid Ventilation; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control*; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011817:Rabbits; D011897:Random Allocation; D015996:Survival Rate; D013997:Time Factors