title: Cardiopulmonary responses during the cooling and the extracorporeal life support rewarming phases in a porcine model of accidental deep hypothermic cardiac arrest.
abstract: BACKGROUND
  This study aimed to assess cardiac and pulmonary pathophysiological responses during cooling and extracorporeal life support (ECLS) rewarming in a porcine model of deep hypothermic cardiac arrest (DHCA). In addition, we evaluated whether providing a lower flow rate of ECLS during the rewarming phase might attenuate cardiopulmonary injuries.
  
  
  METHODS
  Twenty pigs were cannulated for ECLS, cooled until DHCA occurred and subjected to 30 min of cardiac arrest. In order to assess the physiological impact of ECLS on cardiac output we measured flow in the pulmonary artery using Doppler echocardiography as well as a modified thermodilution technique using the Swan-Ganz catheter (injection site in the right ventricle). The animals were randomized into two groups during rewarming: a group with a low blood flow rate of 1.5 L/min (LF group) and a group with a normal flow rate of 3.0 L/min (NF group). The ECLS temperature was adjusted to 5 °C above the central core. Cardiac output, hemodynamics and pulmonary function parameters were evaluated.
  
  
  RESULTS
  During the cooling phase, cardiac output, heart rhythm and blood pressure decreased continuously. Pulmonary artery pressure tended to increase at 32 °C compared to the initial value (20.2 ± 1.7 mmHg vs. 29.1 ± 5.6 mmHg, p = 0.09). During rewarming, arterial blood pressure was higher in the NF than in the LF group at 20° and 25 °C (p = 0.003 and 0.05, respectively). After rewarming to 35 °C, cardiac output was 3.9 ± 0.5 L/min in the NF group vs. 2.7 ± 0.5 L/min in LF group (p = 0.06). At the end of rewarming under ECLS cardiac output was inversely proportional to the ECLS flow rate. Moreover, the ECLS flow rate did not significantly change pulmonary vascular resistance.
  
  
  CONCLUSIONS
  Using a newly developed experimental model of DHCA treated by ECLS, we assessed the cardiac and pulmonary pathophysiological response during the cooling phase and the ECLS rewarming phase. Despite lower metabolic need during hypothermia, a low ECLS blood flow rate during rewarming did not improved cardiopulmonary injuries after rewarming.
  
  
  CONCLUSIONS
  A low ECLS flow rate during the rewarming phase did not attenuate pulmonary lesions, increased blood lactate level and tended to decrease cardiac output after rewarming. A normal ECLS flow rate did not increase pulmonary vascular resistance compared to a low flow rate. This experimental model on pigs contributes a number of pathophysiological findings relevant to the rewarming strategy for patients who have undergone accidental DHCA.
authors.affiliation: Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble, Grenoble, France. gdebaty@chu-grenoble.fr.|University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/Team PRETA, Grenoble, F-38041, France. gdebaty@chu-grenoble.fr.
authors.forename: Guillaume
authors.identifier: http://orcid.org/0000-0003-2879-0326
authors.initials: G
authors.lastname: Debaty
authors.affiliation: Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble, Grenoble, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Maignan
authors.affiliation: University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/Team PRETA, Grenoble, F-38041, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Perrin
authors.affiliation: University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/Team PRETA, Grenoble, F-38041, France.
authors.forename: Angélique
authors.initials: A
authors.lastname: Brouta
authors.affiliation: Department of Biochemistry Toxicology and Pharmacology, University Hospital of Grenoble, Grenoble, France.
authors.forename: Dorra
authors.initials: D
authors.lastname: Guergour
authors.affiliation: Department of Biochemistry Toxicology and Pharmacology, University Hospital of Grenoble, Grenoble, France.
authors.forename: Candice
authors.initials: C
authors.lastname: Trocme
authors.affiliation: Department of cardiac surgery, University Hospital of Grenoble, Grenoble, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bach
authors.affiliation: University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/Team PRETA, Grenoble, F-38041, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Tanguy
authors.affiliation: Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble, Grenoble, France.|University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525/Team PRETA, Grenoble, F-38041, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Briot
mesh_terms: D000818:Animals; D001831:Body Temperature / Q000502:physiology; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology*; D007036:Hypothermia, Induced / Q000379:methods*; D012151:Resuscitation / Q000379:methods*; D017694:Rewarming / Q000379:methods*; D013552:Swine
keywords: Accidental hypothermia; Cardiac arrest; Deep hypothermic cardiac arrest; Extracorporeal life support