A comparison between head cooling begun during cardiopulmonary resuscitation and surface cooling after resuscitation in a pig model of cardiac arrest

作者：Guan, Jun^*; Barbut, Denise; Wang, Hao; Li, Yongqin; Tsai, Min-Shan; Sun, Shijie; Inderbitzen, Becky; Weil, Max Harry; Tang, Wanchun

来源：Critical Care Medicine, 2008, 36(11): S428-S433.

DOI：10.1097/CCM.0b013e31818a8876

• therapeutic hypothermia
• selective brain cooling
• cardiac arrest
• cardiopulmonary resuscitation
• neurologic deficits

Objective: Employing transnasal head-cooling in a pig model of prolonged ventricular fibrillation, we compared the effects of 4 hrs of head-cooling started during cardiopulmonary resuscitation with those of 8 hrs of surface-cooling started at 2 hrs after resuscitation on 96-hr survival and neurologic outcomes.
Design: Prospective controlled animal study.
Setting: University-affiliated research laboratory.
Subjects: Domestic pigs.
Interventions: Twenty-four male pigs were subjected to 10 min of untreated ventricular fibrillation followed by 5 min of cardiopulmonary resuscitation. In the head-cooling group, hypothermia was started with cardiopulmonary resuscitation and continued for 4 hrs after resuscitation. In the surface-cooling group, systemic hypothermia with a cooling blanket was started, in accord with current clinical practices, at 2 hrs after resuscitation and continued for 8 hrs. Methods in the control animal studies were identical except for temperature interventions.
Measurements and Main Results: All animals were resuscitated except for one animal in each of the surface-cooling and control groups. After 5 min of cardiopulmonary resuscitation, jugular vein temperature was significantly decreased in the head-cooled animals. However, there were no differences in pulmonary artery temperatures among the three groups at that time. Nevertheless, both head-cooled and surface-cooled animals had an improved 96-hr survival after resuscitation. Significantly better neurologic outcomes were observed in early head-cooled animals in the first 3 days after resuscitation.
Conclusion: Early head-cooling during cardiopulmonary resuscitation continuing for 4 hrs after resuscitation produced favorable survival and neurologic outcomes in comparison with delayed surface-cooling of 8 hrs duration. (Crit Care Med 2008; 36: [Suppl.]:S428-S433)

• 出版日期2008-11
• 单位中国人民解放军第二军医大学; 天津市中医药研究院附属医院