The Rate of Induction of Hypothermic Arrest Determines the Outcome in a Swine Model of Lethal Hemorrhage
BACKGROUND:Lethal injuries can be surgically repaired under asanguineous hypothermic condition (suspended animation) with excellent outcome. However, the optimal rate for the induction of hypothermic metabolic arrest following uncontrolled lethal hemorrhage (ULH) is unknown. METHODS:ULH was induced...
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| Veröffentlicht in: | The Journal of trauma, injury, infection, and critical care injury, infection, and critical care, 2004-11, Vol.57 (5), p.961-969 |
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| container_title | The Journal of trauma, injury, infection, and critical care |
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| creator | Alam, Hasan B. Chen, Zheng Honma, Kaneatsu Koustova, Elena Ireneo Luis C. Querol, Racel Jaskille, Amin Inocencio, Ryan Ariaban, Nanna Toruno, Kevin Nadel, Amal Rhee, Peter |
| description | BACKGROUND:Lethal injuries can be surgically repaired under asanguineous hypothermic condition (suspended animation) with excellent outcome. However, the optimal rate for the induction of hypothermic metabolic arrest following uncontrolled lethal hemorrhage (ULH) is unknown.
METHODS:ULH was induced in 32 female swine (80–120 lbs) by creating an iliac artery and vein injury, followed 30 minutes later by laceration of the descending thoracic aorta. Through a left thoracotomy approach, total body hypothermic hyperkalemic metabolic arrest was induced by infusing organ preservation fluids into the aorta. Experimental groups werenormothermic controls (no cooling, NC), or hypothermia induced at a rate of 0.5°C/min (slow, SC), 1°C/min (medium, MC), or 2°C/min (fast, FC). Vascular injuries were repaired during the 60 minutes of profound (10°C) hypothermic arrest. Hyperkalemia was reversed by hypokalemic fluid exchange, and blood was infused for resuscitation during the re-warming (0.5°C/ minute) period. The survivors were monitored for 6 weeks.
RESULTS:The 6 week survival rates were 0% (NC), 37.5% (SC), 62.5% (MC), and 87.5% (FC) respectively (p < 0.05 MC&FC versus NC). All of the surviving hypothermic arrest animals were neurologically intact and displayed no long term organ dysfunction.
CONCLUSION:Hypothermic metabolic arrest can be used to maintain viability of key organs during repair of lethal injuries. Survival is influenced by the rate of cooling with the best outcome following rapid induction of hypothermia. |
| doi_str_mv | 10.1097/01.TA.0000149549.72389.3F |
| format | Article |
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METHODS:ULH was induced in 32 female swine (80–120 lbs) by creating an iliac artery and vein injury, followed 30 minutes later by laceration of the descending thoracic aorta. Through a left thoracotomy approach, total body hypothermic hyperkalemic metabolic arrest was induced by infusing organ preservation fluids into the aorta. Experimental groups werenormothermic controls (no cooling, NC), or hypothermia induced at a rate of 0.5°C/min (slow, SC), 1°C/min (medium, MC), or 2°C/min (fast, FC). Vascular injuries were repaired during the 60 minutes of profound (10°C) hypothermic arrest. Hyperkalemia was reversed by hypokalemic fluid exchange, and blood was infused for resuscitation during the re-warming (0.5°C/ minute) period. The survivors were monitored for 6 weeks.
RESULTS:The 6 week survival rates were 0% (NC), 37.5% (SC), 62.5% (MC), and 87.5% (FC) respectively (p < 0.05 MC&FC versus NC). All of the surviving hypothermic arrest animals were neurologically intact and displayed no long term organ dysfunction.
CONCLUSION:Hypothermic metabolic arrest can be used to maintain viability of key organs during repair of lethal injuries. Survival is influenced by the rate of cooling with the best outcome following rapid induction of hypothermia.</description><identifier>ISSN: 0022-5282</identifier><identifier>EISSN: 1529-8809</identifier><identifier>DOI: 10.1097/01.TA.0000149549.72389.3F</identifier><identifier>PMID: 15580018</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Animals ; Aorta, Thoracic - injuries ; Aorta, Thoracic - surgery ; Biological and medical sciences ; Brain Damage, Chronic - etiology ; Cognition - physiology ; Conditioning, Operant ; Disease Models, Animal ; Female ; Hypothermia, Induced - adverse effects ; Hypothermia, Induced - methods ; Iliac Artery - injuries ; Iliac Artery - surgery ; Lacerations - complications ; Lacerations - physiopathology ; Lacerations - surgery ; Medical sciences ; Neurologic Examination ; Shock, Hemorrhagic - etiology ; Shock, Hemorrhagic - physiopathology ; Soft Tissue Injuries - complications ; Soft Tissue Injuries - physiopathology ; Soft Tissue Injuries - surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Swine ; Time Factors ; Treatment Outcome ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><ispartof>The Journal of trauma, injury, infection, and critical care, 2004-11, Vol.57 (5), p.961-969</ispartof><rights>2004 Lippincott Williams & Wilkins, Inc.</rights><rights>2005 INIST-CNRS</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5107-afc8fe717b44da5d68be12b73d3401d6de122cdcc8ccbfa9e731df803c318e5b3</citedby><cites>FETCH-LOGICAL-c5107-afc8fe717b44da5d68be12b73d3401d6de122cdcc8ccbfa9e731df803c318e5b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,776,780,785,786,23909,23910,25118,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16315425$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15580018$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alam, Hasan B.</creatorcontrib><creatorcontrib>Chen, Zheng</creatorcontrib><creatorcontrib>Honma, Kaneatsu</creatorcontrib><creatorcontrib>Koustova, Elena</creatorcontrib><creatorcontrib>Ireneo Luis C. Querol, Racel</creatorcontrib><creatorcontrib>Jaskille, Amin</creatorcontrib><creatorcontrib>Inocencio, Ryan</creatorcontrib><creatorcontrib>Ariaban, Nanna</creatorcontrib><creatorcontrib>Toruno, Kevin</creatorcontrib><creatorcontrib>Nadel, Amal</creatorcontrib><creatorcontrib>Rhee, Peter</creatorcontrib><title>The Rate of Induction of Hypothermic Arrest Determines the Outcome in a Swine Model of Lethal Hemorrhage</title><title>The Journal of trauma, injury, infection, and critical care</title><addtitle>J Trauma</addtitle><description>BACKGROUND:Lethal injuries can be surgically repaired under asanguineous hypothermic condition (suspended animation) with excellent outcome. However, the optimal rate for the induction of hypothermic metabolic arrest following uncontrolled lethal hemorrhage (ULH) is unknown.
METHODS:ULH was induced in 32 female swine (80–120 lbs) by creating an iliac artery and vein injury, followed 30 minutes later by laceration of the descending thoracic aorta. Through a left thoracotomy approach, total body hypothermic hyperkalemic metabolic arrest was induced by infusing organ preservation fluids into the aorta. Experimental groups werenormothermic controls (no cooling, NC), or hypothermia induced at a rate of 0.5°C/min (slow, SC), 1°C/min (medium, MC), or 2°C/min (fast, FC). Vascular injuries were repaired during the 60 minutes of profound (10°C) hypothermic arrest. Hyperkalemia was reversed by hypokalemic fluid exchange, and blood was infused for resuscitation during the re-warming (0.5°C/ minute) period. The survivors were monitored for 6 weeks.
RESULTS:The 6 week survival rates were 0% (NC), 37.5% (SC), 62.5% (MC), and 87.5% (FC) respectively (p < 0.05 MC&FC versus NC). All of the surviving hypothermic arrest animals were neurologically intact and displayed no long term organ dysfunction.
CONCLUSION:Hypothermic metabolic arrest can be used to maintain viability of key organs during repair of lethal injuries. Survival is influenced by the rate of cooling with the best outcome following rapid induction of hypothermia.</description><subject>Animals</subject><subject>Aorta, Thoracic - injuries</subject><subject>Aorta, Thoracic - surgery</subject><subject>Biological and medical sciences</subject><subject>Brain Damage, Chronic - etiology</subject><subject>Cognition - physiology</subject><subject>Conditioning, Operant</subject><subject>Disease Models, Animal</subject><subject>Female</subject><subject>Hypothermia, Induced - adverse effects</subject><subject>Hypothermia, Induced - methods</subject><subject>Iliac Artery - injuries</subject><subject>Iliac Artery - surgery</subject><subject>Lacerations - complications</subject><subject>Lacerations - physiopathology</subject><subject>Lacerations - surgery</subject><subject>Medical sciences</subject><subject>Neurologic Examination</subject><subject>Shock, Hemorrhagic - etiology</subject><subject>Shock, Hemorrhagic - physiopathology</subject><subject>Soft Tissue Injuries - complications</subject><subject>Soft Tissue Injuries - physiopathology</subject><subject>Soft Tissue Injuries - surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Swine</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><issn>0022-5282</issn><issn>1529-8809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkU-P0zAQxS0EYsvCV0DmALdk_bd2jtVC6UpdrQTlbDn2hASSuNiJqv32ONtK9cV649-bGT0j9ImSkpJK3RFaHjYlyYeKSoqqVIzrquTbV2hFJasKrUn1Gq0IYayQTLMb9C6lP5kXguu36IZKqbNZr1B7aAH_sBPg0OCH0c9u6sK4iN3zMUwtxKFzeBMjpAl_hWnRIyScX_DTPLkwAO5GbPHPU67jx-ChX9x7mFrb4x0MIcbW_ob36E1j-wQfLvct-rX9drjfFfun7w_3m33hJCWqsI3TDSiqaiG8lX6ta6CsVtxzQahf-6yY885p5-rGVqA49Y0m3HGqQdb8Fn059z3G8G_OW5uhSw763o4Q5mTWigqhlMxgdQZdDClFaMwxdoONz4YSs8RsCDWHjbnGbF5iNnybvR8vQ-Z6AH91XnLNwOcLYJOzfRPt6Lp05dacSsGWJcSZO4U-Z5v-9vMJomnB9lP7MlpyxQuWf47SrIqlpPh_dpuWLw</recordid><startdate>200411</startdate><enddate>200411</enddate><creator>Alam, Hasan B.</creator><creator>Chen, Zheng</creator><creator>Honma, Kaneatsu</creator><creator>Koustova, Elena</creator><creator>Ireneo Luis C. Querol, Racel</creator><creator>Jaskille, Amin</creator><creator>Inocencio, Ryan</creator><creator>Ariaban, Nanna</creator><creator>Toruno, Kevin</creator><creator>Nadel, Amal</creator><creator>Rhee, Peter</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200411</creationdate><title>The Rate of Induction of Hypothermic Arrest Determines the Outcome in a Swine Model of Lethal Hemorrhage</title><author>Alam, Hasan B. ; Chen, Zheng ; Honma, Kaneatsu ; Koustova, Elena ; Ireneo Luis C. Querol, Racel ; Jaskille, Amin ; Inocencio, Ryan ; Ariaban, Nanna ; Toruno, Kevin ; Nadel, Amal ; Rhee, Peter</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5107-afc8fe717b44da5d68be12b73d3401d6de122cdcc8ccbfa9e731df803c318e5b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Animals</topic><topic>Aorta, Thoracic - injuries</topic><topic>Aorta, Thoracic - surgery</topic><topic>Biological and medical sciences</topic><topic>Brain Damage, Chronic - etiology</topic><topic>Cognition - physiology</topic><topic>Conditioning, Operant</topic><topic>Disease Models, Animal</topic><topic>Female</topic><topic>Hypothermia, Induced - adverse effects</topic><topic>Hypothermia, Induced - methods</topic><topic>Iliac Artery - injuries</topic><topic>Iliac Artery - surgery</topic><topic>Lacerations - complications</topic><topic>Lacerations - physiopathology</topic><topic>Lacerations - surgery</topic><topic>Medical sciences</topic><topic>Neurologic Examination</topic><topic>Shock, Hemorrhagic - etiology</topic><topic>Shock, Hemorrhagic - physiopathology</topic><topic>Soft Tissue Injuries - complications</topic><topic>Soft Tissue Injuries - physiopathology</topic><topic>Soft Tissue Injuries - surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Swine</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><toplevel>online_resources</toplevel><creatorcontrib>Alam, Hasan B.</creatorcontrib><creatorcontrib>Chen, Zheng</creatorcontrib><creatorcontrib>Honma, Kaneatsu</creatorcontrib><creatorcontrib>Koustova, Elena</creatorcontrib><creatorcontrib>Ireneo Luis C. Querol, Racel</creatorcontrib><creatorcontrib>Jaskille, Amin</creatorcontrib><creatorcontrib>Inocencio, Ryan</creatorcontrib><creatorcontrib>Ariaban, Nanna</creatorcontrib><creatorcontrib>Toruno, Kevin</creatorcontrib><creatorcontrib>Nadel, Amal</creatorcontrib><creatorcontrib>Rhee, Peter</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of trauma, injury, infection, and critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alam, Hasan B.</au><au>Chen, Zheng</au><au>Honma, Kaneatsu</au><au>Koustova, Elena</au><au>Ireneo Luis C. Querol, Racel</au><au>Jaskille, Amin</au><au>Inocencio, Ryan</au><au>Ariaban, Nanna</au><au>Toruno, Kevin</au><au>Nadel, Amal</au><au>Rhee, Peter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Rate of Induction of Hypothermic Arrest Determines the Outcome in a Swine Model of Lethal Hemorrhage</atitle><jtitle>The Journal of trauma, injury, infection, and critical care</jtitle><addtitle>J Trauma</addtitle><date>2004-11</date><risdate>2004</risdate><volume>57</volume><issue>5</issue><spage>961</spage><epage>969</epage><pages>961-969</pages><issn>0022-5282</issn><eissn>1529-8809</eissn><abstract>BACKGROUND:Lethal injuries can be surgically repaired under asanguineous hypothermic condition (suspended animation) with excellent outcome. However, the optimal rate for the induction of hypothermic metabolic arrest following uncontrolled lethal hemorrhage (ULH) is unknown.
METHODS:ULH was induced in 32 female swine (80–120 lbs) by creating an iliac artery and vein injury, followed 30 minutes later by laceration of the descending thoracic aorta. Through a left thoracotomy approach, total body hypothermic hyperkalemic metabolic arrest was induced by infusing organ preservation fluids into the aorta. Experimental groups werenormothermic controls (no cooling, NC), or hypothermia induced at a rate of 0.5°C/min (slow, SC), 1°C/min (medium, MC), or 2°C/min (fast, FC). Vascular injuries were repaired during the 60 minutes of profound (10°C) hypothermic arrest. Hyperkalemia was reversed by hypokalemic fluid exchange, and blood was infused for resuscitation during the re-warming (0.5°C/ minute) period. The survivors were monitored for 6 weeks.
RESULTS:The 6 week survival rates were 0% (NC), 37.5% (SC), 62.5% (MC), and 87.5% (FC) respectively (p < 0.05 MC&FC versus NC). All of the surviving hypothermic arrest animals were neurologically intact and displayed no long term organ dysfunction.
CONCLUSION:Hypothermic metabolic arrest can be used to maintain viability of key organs during repair of lethal injuries. Survival is influenced by the rate of cooling with the best outcome following rapid induction of hypothermia.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>15580018</pmid><doi>10.1097/01.TA.0000149549.72389.3F</doi><tpages>9</tpages></addata></record> |
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| subjects | Animals Aorta, Thoracic - injuries Aorta, Thoracic - surgery Biological and medical sciences Brain Damage, Chronic - etiology Cognition - physiology Conditioning, Operant Disease Models, Animal Female Hypothermia, Induced - adverse effects Hypothermia, Induced - methods Iliac Artery - injuries Iliac Artery - surgery Lacerations - complications Lacerations - physiopathology Lacerations - surgery Medical sciences Neurologic Examination Shock, Hemorrhagic - etiology Shock, Hemorrhagic - physiopathology Soft Tissue Injuries - complications Soft Tissue Injuries - physiopathology Soft Tissue Injuries - surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Swine Time Factors Treatment Outcome Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels |
| title | The Rate of Induction of Hypothermic Arrest Determines the Outcome in a Swine Model of Lethal Hemorrhage |
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