This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Weinrauch, V. Articles by Radovsky, A. Search for Related Content PubMed PubMed Citation Articles by Weinrauch, V. Articles by Radovsky, A.

Stroke, Vol 23, 1454-1462, Copyright © 1992 by American Heart Association

ARTICLES

Beneficial effect of mild hypothermia and detrimental effect of deep hypothermia after cardiac arrest in dogs

V Weinrauch, P Safar, S Tisherman, K Kuboyama and A Radovsky
International Resuscitation Research Center, University of Pittsburgh School of Medicine, Pa.

BACKGROUND AND PURPOSE: Mild cerebral hypothermia (34 degrees C) induced immediately after cardiac arrest improves outcome. Deep postarrest hypothermia (15 degrees C) has not been studied. METHODS: We used our dog model of normothermic ventricular fibrillation (no blood flow) of 12.5 minutes, reperfusion by brief cardiopulmonary bypass, controlled ventilation to 20 hours, and intensive care to 72 hours. Head surface cooling and bypass cooling were performed from start of reperfusion to 1 hour. Five groups of six dogs each were compared: group I, normothermic controls; group II, deep hypothermia (15 degrees C); group III, moderate hypothermia (30 degrees C); group IV, mild hypothermia (34 degrees C); and group V, mild hypothermia with head surface cooling begun during no flow. RESULTS: In control group I, five dogs remained comatose (overall performance category [OPC] 4) and one severely disabled (OPC 3). In group II, four dogs achieved OPC 4 and two dogs OPC 3 (NS versus group I). Compared with group I, OPCs were better in group III (p less than 0.05), group IV (p less than 0.05), and group V (p less than 0.05). Neurological deficit scores were also better in groups III, IV, and V than in groups I or II (p less than 0.05). Total brain histological damage scores were better in group III (p = 0.02), group IV (p = 0.06), and group V (p less than 0.05) than in group I. In group II, OPC and neurological deficit scores were the same and histological damage scores numerically worse than in group I and all were worse than in groups III, IV, and V (p less than 0.05). Cardiovascular complications and myocardial morphological damage in groups II and III were worse than in groups I, IV, and V (p less than 0.05). CONCLUSIONS: Mild or moderate cerebral hypothermia induced immediately after cardiac arrest improves cerebral outcome, more likely when initiated during arrest, whereas deep postarrest hypothermia can worsen cerebral and cardiac outcome.

This article has been cited by other articles:

				B. P. Meloni, F. L. Mastaglia, and N. W. Knuckey Review: Therapeutic applications of hypothermia in cerebral ischaemia Therapeutic Advances in Neurological Disorders, September 1, 2008; 1(2): 75 - 98. [Abstract] [PDF]

				D. Yannopoulos and T. Aufderheide Acute management of sudden cardiac death in adults based upon the new CPR guidelines Europace, January 1, 2007; 9(1): 2 - 9. [Abstract] [Full Text] [PDF]

				A. Nozari, P. Safar, S. W. Stezoski, X. Wu, S. Kostelnik, A. Radovsky, S. Tisherman, and P. M. Kochanek Critical Time Window for Intra-Arrest Cooling With Cold Saline Flush in a Dog Model of Cardiopulmonary Resuscitation Circulation, June 13, 2006; 113(23): 2690 - 2696. [Abstract] [Full Text] [PDF]

				C. M. Gebauer, M. Knuepfer, E. Robel-Tillig, F. Pulzer, and C. Vogtmann Hemodynamics Among Neonates With Hypoxic-Ischemic Encephalopathy During Whole-Body Hypothermia and Passive Rewarming Pediatrics, March 1, 2006; 117(3): 843 - 850. [Abstract] [Full Text] [PDF]

				S. Shankaran, A. R. Laptook, R. A. Ehrenkranz, J. E. Tyson, S. A. McDonald, E. F. Donovan, A. A. Fanaroff, W. K. Poole, L. L. Wright, R. D. Higgins, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N. Engl. J. Med., October 13, 2005; 353(15): 1574 - 1584. [Abstract] [Full Text] [PDF]

				M. S. Damian, D. Ellenberg, R. Gildemeister, J. Lauermann, G. Simonis, W. Sauter, and C. Georgi Coenzyme Q10 Combined With Mild Hypothermia After Cardiac Arrest: A Preliminary Study Circulation, November 9, 2004; 110(19): 3011 - 3016. [Abstract] [Full Text] [PDF]

				M. P. Anstadt and J. E. Lowe Cardiopulmonary Resuscitation Card. Surg. Adult, January 1, 2003; 2(2003): 471 - 494. [Full Text]

				A. J. Gunn and L. Bennet Cerebral Hypothermia in the Management of Hypoxic-Ischemic Encephalopathy NeoReviews, June 1, 2002; 3(6): e116 - 122. [Full Text]

				L. B. Becker, M. L. Weisfeldt, M. H. Weil, T. Budinger, J. Carrico, K. Kern, G. Nichol, I. Shechter, R. Traystman, C. Webb, et al. The PULSE Initiative: Scientific Priorities and Strategic Planning for Resuscitation Research and Life Saving Therapies Circulation, May 28, 2002; 105(21): 2562 - 2570. [Full Text] [PDF]

				The Hypothermia after Cardiac Arrest Study Group Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest N. Engl. J. Med., February 21, 2002; 346(8): 549 - 556. [Abstract] [Full Text] [PDF]

				S. A. Bernard, T. W. Gray, M. D. Buist, B. M. Jones, W. Silvester, G. Gutteridge, and K. Smith Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia N. Engl. J. Med., February 21, 2002; 346(8): 557 - 563. [Abstract] [Full Text] [PDF]

				A. R. Laptook, L. Shalak, and R. J. T. Corbett Differences in Brain Temperature and Cerebral Blood Flow During Selective Head Versus Whole-Body Cooling Pediatrics, November 1, 2001; 108(5): 1103 - 1110. [Abstract] [Full Text] [PDF]

				R. A. Felberg, D. W. Krieger, R. Chuang, D. E. Persse, W. S. Burgin, S. L. Hickenbottom, L. B. Morgenstern, O. Rosales, and J. C. Grotta Hypothermia After Cardiac Arrest: Feasibility and Safety of an External Cooling Protocol Circulation, October 9, 2001; 104(15): 1799 - 1804. [Abstract] [Full Text] [PDF]

				G. A. Ewy and J. P. Ornato Emergency cardiac care: introduction J. Am. Coll. Cardiol., March 15, 2000; 35(4): 825 - 880. [Full Text] [PDF]

				P. Safar, F. Xiao, A. Radovsky, K. Tanigawa, U. Ebmeyer, N. Bircher, H. Alexander, and S. W. Stezoski Improved Cerebral Resuscitation From Cardiac Arrest in Dogs With Mild Hypothermia Plus Blood Flow Promotion Stroke, January 1, 1996; 27(1): 105 - 113. [Abstract] [Full Text]