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J Thorac Cardiovasc Surg 2002;123:724-734
© 2002 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology (CSP)

Prolonged mild hypothermia after experimental hypothermic circulatory arrest in a chronic porcine model

From the Departments of Surgery,^a Anesthesiology,^b and Forensic Medicine,^c and Laboratory of Clinical Neurophysiology,^d Oulu University Hospital, University of Oulu, Oulu, Finland.

Supported by grants from the Oulu University Hospital, the Finnish Foundation for Cardiovascular Research, and the Sigrid Juselius Foundation.

Received for publication April 24, 2001. Revisions requested July 9, 2001; revisions received July 17, 2001. Accepted for publication July 24, 2001. Address for reprints: Tatu Juvonen, MD, PhD, Department of Surgery, Oulu University Hospital, PO Box 22, 90221 Oulu, Finland (E-mail: tatu.juvonen{at}oulu.fi).

Objectives: We sought to evaluate the potential efficacy of prolonged mild hypothermia after hypothermic circulatory arrest.
Methods: Twenty pigs, after a 75-minute period of hypothermic circulatory arrest, were randomly assigned to be rewarmed to 37°C (normothermia group) or to 32°C and kept at that temperature for 14 hours from the start of rewarming (hypothermia group).
Results: The 7-day survival was 30% in the hypothermia group and 70% in the normothermia group (P = .08). The hypothermia group had poorer postoperative behavioral scores than the normothermia group. Prolonged hypothermia was associated with lower oxygen extraction and consumption rates and higher mixed venous oxygen saturation levels during the first hours after hypothermic circulatory arrest. Decreased cardiac index, lower pH, and higher partial pressure of carbon dioxide were observed in the hypothermia group. There was a trend for beneficial effect of prolonged hypothermia in terms of lower brain lactate levels until the 4-hour interval and of intracranial pressure until the 10-hour interval. Postoperatively, total leukocyte and neutrophil counts were lower, and creatine kinase BB was significantly increased in the hypothermia group. At extubation, the hypothermia group had higher oxygen extraction rates and lower brain tissue oxygen tension.
Conclusions: A 14-hour period of mild hypothermia after 75-minute hypothermic circulatory arrest seems to be associated with poor outcome. However, the results of this study suggest that mild hypothermia may preserve its efficacy when it is used for no longer than 4 hours, but the potentials of a shorter period of postoperative mild hypothermia still require further investigation.

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