Orhan ÇINAR, Yahya Ayhan ACAR, Banu YILMAZ KARAKUŞ, Duygu Sultan ÇELİK, Aylin HAKLIGÖR, Hatice TOPÇU, Şule ÖZSOY, Erdem ÇEVİK

Transpulmonary Hypothermia with Cooled Oxygen Inhalation Shows Promising Results as a Novel Hypothermia Technique

Background: Therapeutic hypothermia was showed to improve neurologic outcome but current therapeutic hypothermia techniques have limitations. Novel techniques such as transpulmonary hypothermia with cooled oxygen inhalation may be beneficial. Aims: To evaluate the performance of transthoracic hypothermia with cooled medical oxygen inhalation as a therapeutic hypothermia method. Study Design: Animal experimentation. Methods: A total of 36 adult male Wistar-Hannover rats were used in this research. Rats were randomised into four groups: group 1, Cooled oxygen group; group 2, IV cold fluid group; group 3, Surface cooling group; group 4, control group. No hypothermia method was applied in the control group. Hypothermia techniques were administered in the other three groups until the targeted core temperature was maintained. The target temperature was continued for one hour at 32-34 °C. After that, rats were heated up with hot blankets. Once the rectal temperature reached 38 °C, rats were euthanised. The main outcomes were the rate of temperature decrease (°C per minute) (S) and the time required to reach the target body temperature (T). Results: All rats survived the study protocol. When compared to the control group, T and S values were better in the cooled medical oxygen inhalation group (p

PDF

___

Moore EM, Nichol AD, Bernard SA, Bellomo R. Therapeutic hypothermia: benefits, mechanisms and potential clinical applications in neurological, cardiac and kidney injury. Injury 2011;42:843-54.
Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346:549-56.
Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, et al. Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):768- 86.
Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, et al. Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132(18 Suppl 2):465-82.
Donnino MW, Andersen LW, Berg KM, Reynolds JC, Nolan JP, Morley PT, et al. T Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation 2016;98:97-104.
Kumar MM, Goldberg AD, Kashiouris M, Keenan LR, Rabinstein AA, Afessa B, et al. Transpulmonary hypothermia: a novel method of rapid brain cooling through augmented heat extraction from the lungs. Resuscitation 2014;85:1405-10.
Acar YA, Cevik E, Cınar O. A novel technique for therapeutic hypothermia: cooled oxygen inhalation. Am J Emerg Med 2014;32:384.
Acar YA, Çevik E, Karakuş B, Çınar O, Haklıgör A, Özsoy Ş, et al. Transpulmonary hypothermia with cooled oxygen inhalation. Resuscitation 2015;88:e1.
Henderson RB, Hobbs JA, Mathies M, Hogg N. Rapid recruitment of inflammatory monocytes is independent of neutrophil migration. Blood 2003;102:328-35.
Mitchel RN. Inflammation and repair. In: Kumar V, Abbas A, Aster J, editors. Robbins Basic Pathology. 9th ed. Philadelphia: Elsevier Saunders; 2012:82.
Kämäräinen A, Virkkunen I, Tenhunen J, Yli-Hankala A, Silfvast T. Prehospital therapeutic hypothermia for comatose survivors of cardiac arrest: a randomized controlled trial. Acta Anaesthesiol Scand 2009;53:900-7.
Kim F, Olsufka M, Longstreth WT Jr, Maynard C, Carlbom D, Deem S, et al. Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline. Circulation 2007;115:3064-70.
Behringer W, Arrich J, Holzer M, Sterz F. Out-of-hospital therapeutic hypothermia in cardiac arrest victims. Scand J Trauma Resusc Emerg Med 2009;17:52.
Kliegel A, Losert H, Sterz F, Kliegel M, Holzer M, Uray T, et al. Cold simple intravenous infusions preceding special endovascular cooling for faster induction of mild hypothermia after cardiac arresta feasibility study. Resuscitation 2005;64:347-51.
Castrén M, Nordberg P, Svensson L, Taccone F, Vincent JL, Desruelles D, et al. Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation 2010;122:729-36.
Saha JK, Xia J, Grondin JM, Engle SK, Jakubowski JA. Acute hyperglycemia induced by ketamine/xylazine anesthesia in rats: mechanisms and implications for preclinical models. Exp Biol Med (Maywood) 2005;230:777-84.
Wellington D, Mikaelian I, Singer L. Comparison of ketamine-xylazine and ketamine-dexmedetomidine anesthesia and intraperitoneal tolerance in rats. J Am Assoc Lab Anim Sci 2013;52:481-7.
Larsson K, Tornling G, Gavhed D, Müller-Suur C, Palmberg L. Inhalation of cold air increases the number of inflammatory cells in the lungs in healthy subjects. Eur Respir J 1998;12:825-30.
Tsuno K, Miura K, Takeya M, Kolobow T, Morioka T. Histopathologic pulmonary changes from mechanical ventilation at high peak airway pressures. Am Rev Respir Dis 1991;143:1115-20.