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Systemic cooling cardiac protection

Amneet Sandhu, Joseph L Schuller, Wendy S Tzou, Alexis Z Tumolo, William H Sauer, Duy T Nguyen
A 62-year-old man was referred to our institution for high-density, symptomatic premature ventricular contractions (PVCs) with resultant decrease in left ventricular (LV) function having failed prior ablation attempts. Successful, durable ablation of the patient's mid-myocardial PVC arising from the LV summit region was achieved through the proximal great cardiac vein with ablation depth augmented by use of half-normal saline irrigant. Though standard ablation of ventricular arrhythmias using normal saline irrigation from the coronary venous system has been well-reported, this may be of limited value in addressing mid-myocardial sites of origin...
October 20, 2018: Pacing and Clinical Electrophysiology: PACE
Yangyang Zou, Limin Chen, Tianfeng Hua, Min Yang
OBJECTIVE: To investigate the protective function of endovascular cooling method on post-resuscitation syndrome (PRS) in porcine cardiac arrest (CA) model and its mechanism. METHODS: Ventricular fibrillation (VF) was electrically induced and untreated for 8 minutes in 15 healthy male porcines, cardiopulmonary resuscitation (CPR) was then initiated. All successful recovery animals were randomly divided into two groups by random number table. In normal temperature group, the core temperature was maintained at (38...
September 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Martin Manninger, Alessio Alogna, David Zweiker, Birgit Zirngast, Stefan Reiter, Viktoria Herbst, Heinrich Maechler, Burkert M Pieske, Frank R Heinzel, Helmut Brussee, Heiner Post, Daniel Scherr
OBJECTIVE: Application of therapeutic mild hypothermia in patients after resuscitation, often accompanied by myocardial infarction, cardiogenic shock, and systemic inflammation may impact on cardiac rhythm. We therefore tested susceptibility to atrial arrhythmias during hyperthermia (HT, 40.5°C), normothermia (NT, 38.0°C), and mild hypothermia (MH, 33.0°C). METHODS: Nine healthy, anesthetized closed-chest landrace pigs were instrumented with a quadripolar stimulation catheter in the high right atrium and a decapolar catheter in the coronary sinus...
April 16, 2018: Pacing and Clinical Electrophysiology: PACE
Karl Waked, Marc Schepens
During open thoracoabdominal aortic aneurysm repair (OTAAAR), there is an inevitable organ ischemic period that occurs when the abdominal arteries are being reattached to the aortic graft. Despite various protective techniques, the incidence of renal and visceral complications remains substantial. This state-of-the-art review gives an overview of the current and most evidence-based organ protection methods during OTAAAR, based on the most recent publications and personal experience. An electronic search was performed in four medical databases, using the following MeSH terms: thoracoabdominal aneurysm, TAAAR, visceral protection, renal protection, kidney, perfusion, and intestines...
2018: Journal of Visualized Surgery
Zachary J Schlader, Morgan C O'Leary, James R Sackett, Blair D Johnson
NEW FINDINGS: What is the central question of this study? Does passive heat stress attenuate the increase in cardiac parasympathetic stimulation, vascular resistance and blood pressure evoked by face cooling? What is the main finding and its importance? Passive heat stress attenuates the capacity to increase cardiac parasympathetic activation and impairs the ability to increase vascular resistance during sympathoexcitation, which ultimately results in a relative inability to increase blood pressure...
May 1, 2018: Experimental Physiology
Jan Sedlacik, Åsmund Kjørstad, Zsuzsanna Nagy, Jan-Hendrik Buhk, Christoph R Behem, Constantin J Trepte, Jens Fiehler, Fabian Temme
Early, prehospital cooling seeks to reduce and control the body temperature as early as possible to protect the brain and improve patient outcome in cardiac arrest, stroke, and traumatic brain injury. In this study, we investigate the feasibility of localized cooling of the porcine brain by using a novel high-flow cold air protocol, which utilizes the close proximity between the nasal cavity and the brain. Five adult pigs were anesthetized and temperature change was mapped before, during, and after cooling by using the proton resonance frequency method on a 3 T Siemens Magnetom Skyra system...
March 2018: Therapeutic Hypothermia and Temperature Management
Aleksander Trąbka-Zawicki, Marek Tomala, Aleksander Zeliaś, Elżbieta Paszek, Wojciech Zajdel, Ewa Stępień, Krzysztof Żmudka
BACKGROUND: The use of mild therapeutic hypothermia (MTH) in patients after out-of-hospital cardiac arrest (OHCA) who are undergoing primary percutaneous coronary intervention (pPCI) can protect patients from thromboembolic complications. The aim of the study was to evaluate the adaptive mechanisms of the coagulation system in MTH-treated comatose OHCA survivors. METHODS: Twenty one comatose OHCA survivors with acute coronary syndrome undergoing immediate pPCI were treated with MTH...
July 11, 2017: Cardiology Journal
Marie-Sophie Grave, Fritz Sterz, Alexander Nürnberger, Stergios Fykatas, Mathias Gatterbauer, Albert Friedrich Stättermayer, Andreas Zajicek, Reinhard Malzer, Dieter Sebald, Raphael van Tulder
We investigated feasibility and safety of the RhinoChill (RC) transnasal cooling system initiated before achieving a protected airway during cardiopulmonary resuscitation (CPR) in a prehospital setting.In out-of-hospital cardiac arrest (OHCA), transnasal evaporative cooling was initiated during CPR, before a protected airway was established and continued until either the patient was declared dead, standard institutional systemic cooling methods were implemented or cooling supply was empty. Patients were monitored throughout the hypothermia period until either death or hospital discharge...
August 2016: Medicine (Baltimore)
Filippo Benassi, Enrico Giuliani, Davide Corticelli, Roberto Parravicni
UNLABELLED: Abstract PURPOSE: several therapeutic options are used in emergency situations, when heart and/or lung functions acutely fail. Because of the poor results of conventional treatments, the use of an extra-corporeal life support (ECLS) systems able to completely assume the heart and lung functions in emergency situations is becoming a viable alternative. We have developed a unique ECLS system for patients needing extended respiratory and/or circulatory support and controlled hypothermia...
May 6, 2016: Acta Bio-medica: Atenei Parmensis
Tamer Elghobary, Idris M Ali, Ahmad F Ahmad
OBJECTIVES: Myocardial hypertrophy represents a great challenge in cardiac surgery. Several strategies have been described to protect the hypertrophied myocardium during cardiopulmonary bypass, and aortic clamping, yet the ideal strategy has not been identified. This study investigates the use of moderate systemic hypothermia (MSH) as an adjuvant method to protect the hypertrophied myocardium in patients undergoing aortic valve replacement (AVR). METHODS: Twenty eight patients undergoing AVR were divided into two groups, (Group I) received continuous cold 5-8 °C retrograde blood cardioplegia (CRBC) and their body temperature was cooled down to 23-26 °C...
2011: Open Journal of Cardiovascular Surgery
Matthias Kohlhauer, Fanny Lidouren, Isabelle Remy-Jouet, Nicolas Mongardon, Clovis Adam, Patrick Bruneval, Hakim Hocini, Yves Levy, Fabiola Blengio, Pierre Carli, Benoit Vivien, Jean-Damien Ricard, Philippe Micheau, Hervé Walti, Mathieu Nadeau, Raymond Robert, Vincent Richard, Paul Mulder, David Maresca, Charlie Demené, Mathieu Pernot, Mickael Tanter, Bijan Ghaleh, Alain Berdeaux, Renaud Tissier
OBJECTIVES: Total liquid ventilation provides ultrafast and potently neuro- and cardioprotective cooling after shockable cardiac arrest and myocardial infarction in animals. Our goal was to decipher the effect of hypothermic total liquid ventilation on the systemic and cerebral response to asphyxial cardiac arrest using an original pressure- and volume-controlled ventilation strategy in rabbits. DESIGN: Randomized animal study. SETTING: Academic research laboratory...
October 2015: Critical Care Medicine
Jing Li, Huashan Wang, Qiang Zhong, Xiangdong Zhu, Sy-Jou Chen, Yuanyu Qian, Jim Costakis, Gabrielle Bunney, David G Beiser, Alan R Leff, E Douglas Lewandowski, J Michael ÓDonnell, Terry L Vanden Hoek
Sudden cardiac arrest (SCA) is a leading cause of death in the United States. Despite return of spontaneous circulation, patients die due to post-SCA syndrome that includes myocardial dysfunction, brain injury, impaired metabolism, and inflammation. No medications improve SCA survival. Our prior work suggests that optimal Akt activation is critical for cooling protection and SCA recovery. Here, we investigate a small inhibitor of PTEN, an Akt-related phosphatase present in heart and brain, as a potential therapy in improving cardiac and neurological recovery after SCA...
June 1, 2015: American Journal of Physiology. Heart and Circulatory Physiology
Ping Gong, Hong Zhao, Rong Hua, Mingyue Zhang, Ziren Tang, Xue Mei, Juan Cui, Chunsheng Li
Complement activation has been implicated in ischemia/reperfusion injury. This study aimed to determine whether mild hypothermia (HT) inhibits systemic and cerebral complement activation after resuscitation from cardiac arrest. Sixteen minipigs resuscitated from 8 minutes of untreated ventricular fibrillation were randomized into two groups: HT group (n=8), treated with HT (33°C) for 12 hours; and normothermia group (n=8), treated similarly as HT group except for cooling. Blood samples were collected at baseline and 0...
August 2015: Journal of Cerebral Blood Flow and Metabolism
Rafael Badenes, Angels Lozano, F Javier Belda
Postoperative pulmonary dysfunction (PPD) is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC) and mechanical ventilation (VM)...
2015: Critical Care Research and Practice
P Fernandes, P Allen, M Valdis, L Guo
UNLABELLED: A 30-year-old female gravida 1 (37 weeks + 5 days gestation) underwent a crash Cesarean section for evidence of fetal distress, with the presumed diagnosis of placental abruption. Immediately post-op, the patient had a complete cardiovascular collapse with pulseless electrical activity, requiring cardiopulmonary resuscitation (CPR). Two doses of thrombolytics (Tenecteplase) were administered during the resuscitation, with a presumed diagnosis of a pulmonary embolism. After approximately 45 minutes into the resuscitation, the cardiac surgery team was called to initiate extracorporeal membrane oxygenation (ECMO)...
March 2015: Perfusion
Marek Bartkowiak, Paweł Bugajski, Tomasz Siminiak, Ryszard Kalawski
BACKGROUND: Extracorporeal circulation used during coronary artery bypass grafting triggers systemic inflammatory response with neutrophil activation which adversely affects ischaemic/reperfused myocardium. One method of myocardial protection during cardiac surgery is the use of blood cardioplegia. Its protective effect is related to cardiac cooling and metabolism reduction, oxygen supply from erythrocytes, and reactive oxygen species scavenging. However, blood cardioplegia is also associated with myocardial damage induced by undesirable morphotic blood elements...
2013: Kardiologia Polska
Levi Bassin, Ah Chot Yong, David Kilpatrick, Stephen Nicholas Hunyor
BACKGROUND: Therapeutic hypothermia (TH) is used to mitigate cerebral injury after an out of hospital cardiac arrest. There is a perceived risk of increased arrhythmias with temperatures lower than the current target of 32-34°C for TH. This study sought to develop and investigate the electrophysiological changes in a sheep model of systemic hypothermia regarding the susceptibility to ventricular arrhythmias. METHODS: Ten sheep underwent systemic hypothermia using a venous-venous extra-corporeal circuit whilst instrumented with a 12 lead ECG...
January 2014: Heart, Lung & Circulation
Haris Bilal, Bridie O'Neill, Sarah Mahmood, Paul Waterworth
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is cerebrospinal fluid (CSF) drainage of benefit in patients undergoing surgery on the descending thoracic aorta or thoracoabdominal aorta?' Altogether 1177 papers were found using the reported search, of which 17 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated...
October 2012: Interactive Cardiovascular and Thoracic Surgery
Bridie O'Neill, Haris Bilal, Sarah Mahmood, Paul Waterworth
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Is it worth packing the head with ice in patients undergoing deep hypothermic circulatory arrest (DHCA)? Altogether more than 34 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question, 5 of which were animal studies, 1 was a theoretical laboratory study and 1 study looked at the ability to cool using circulating water 'jackets' in humans...
October 2012: Interactive Cardiovascular and Thoracic Surgery
Paolo Della Pina, Enrico Vizzardi, Riccardo Raddino, Mara Gavazzoni, Giorgio Caretta, Elio Gorga, Livio Dei Cas
The last 20 years was characterized by great improvements in the efficacy and tolerability of anticancer therapies. Most of these changes are related to the introduction of targeted drugs, which presents a better activity on the biology of cancer and less toxicity. Nevertheless, the initial enthusiasm was cooled by the emerging evidences of cardiac side effects. The aim of this review is to describe the actual knowledge about the possible cardiotoxicity of targeted drugs. The most important need is the detection of early cardiotoxicity and the evidence of subtle myocardial dysfunction that allows to begin a protective therapy...
December 2012: Cardiovascular Toxicology
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