A computationally guided study of a blood heat exchanger and the construction of an extracorporeal circulation system for selective brain cooling

Achieving long-lasting hypothermia neuroprotection against reperfusion injury in patients with acute ischemic stroke (AIS) by using intra-arterial selective cooling infusion with autologous blood (IA-SCAI) is promising. However, due to the lack of a specialized medical circulatory perfusion system matching cerebral blood flow characteristics, we conduct a translational study of an extracorporeal circulation system for continuous and controllable brain cooling using an optimized blood heat exchanger (BHE). In contrast to commercial BHEs, optimized BHEs are prone to reducing thrombogenic risk potential under a low infusion rate (10–50 mL/min) in IA-SCAI. The designed BHE provided effective cerebral cooling (∼2°C) for 22 min during a 30-min cooling period in a swine model. These results suggest that the selective brain cooling induced by cold autologous blood perfusion was safe, which could promote the clinical application of an autologous extracorporeal circulation system for AIS therapy. [Display omitted] •Constructs an extracorporeal system for continuous, controllable brain cooling•Optimized BHE demonstrates superiority in low thrombogenic risk•Achieved long-lasting targeted brain hypothermia (∼2°C) for 22 min•Promoted clinical applications of the circulation system for AIS therapy Jiang et al. construct an extracorporeal system for continuous, controllable brain cooling and promote clinical applications of the circulation system for AIS therapy. The thermodynamic/hemodynamic optimizations of a blood heat exchanger prove to be effective and safe with low thrombogenic risk and achieve long-lasting targeted brain hypothermia (∼2°C) for 22 min on selective brain cooling.