Effect of mild hypothermia on renal ischemia/reperfusion injury after cardiopulmonary resuscitation in a swine model

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Abstract

Abstract Purpose: To investigate the effect of intravascular cooling on renal function after resuscitation. Methods: Twenty four pigs were randomized into three groups (n=8 in each group): therapeutic hypothermia group (TH group), normothermia group (NH group) and sham operation group (SHAM group). After 6 minutes of untreated VF, CPR was performed. Upon ROSC, the TH group received the intravascular cooling. The NH and SHAM group did not undergo therapeutic hypothermia. Haemodynamic parameters were recorded. The bloods were analyzed for serum creatinine (sCr), CysC and NGAL. The kidney was surgically removed observe pathologic changes under a light microscope. Results: The sCr increased in both TH and NH groups after ROSC, compared to baseline. Between two groups, the sCr and creatinine clearance (Cc) showed lower level in the TH group. The urine volume per hour in the TH group were higher during cooling. After resuscitation, NGAL and CysC in the NH group were higher than in the TH group. Under the light microscope, compared with the TH group, the renal injury was prominent in the NH group. Conclusion: Mild hypothermia had a protection to renal ischemia reperfusion injury after resuscitation.

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World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.

(2013)

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Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.

Stephen Bernard, Timothy W. Gray, Michael Buist … (2002)

Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest. The study subjects were 77 patients who were randomly assigned to treatment with hypothermia (with the core body temperature reduced to 33 degrees C within 2 hours after the return of spontaneous circulation and maintained at that temperature for 12 hours) or normothermia. The primary outcome measure was survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility. The demographic characteristics of the patients were similar in the hypothermia and normothermia groups. Twenty-one of the 43 patients treated with hypothermia (49 percent) survived and had a good outcome--that is, they were discharged home or to a rehabilitation facility--as compared with 9 of the 34 treated with normothermia (26 percent, P=0.046). After adjustment for base-line differences in age and time from collapse to the return of spontaneous circulation, the odds ratio for a good outcome with hypothermia as compared with normothermia was 5.25 (95 percent confidence interval, 1.47 to 18.76; P=0.011). Hypothermia was associated with a lower cardiac index, higher systemic vascular resistance, and hyperglycemia. There was no difference in the frequency of adverse events. Our preliminary observations suggest that treatment with moderate hypothermia appears to improve outcomes in patients with coma after resuscitation from out-of-hospital cardiac arrest.

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Successful cardiopulmonary resuscitation after cardiac arrest as a "sepsis-like" syndrome.

Christophe Adrie, Minou Adib-Conquy, Ivan Laurent … (2002)

We investigated the immunoinflammatory profile of patients successfully resuscitated after cardiac arrest, representing a model of whole-body ischemia/reperfusion syndrome. Plasma cytokine, endotoxin, and ex vivo cytokine production in whole-blood assays was assessed in 61, 35, and 11 patients, respectively. On admission, high levels of plasma interleukin (IL)-6, IL-8, IL-10, and soluble tumor necrosis factor (TNF) receptor type II could discriminate between survivors and nonsurvivors. Among nonsurvivors, the initial need for a vasopressor agent was associated with higher levels of IL-1 receptor antagonist, IL-10, and IL-6 on day 1. Plasma endotoxin was detected in 46% of the analyzed patients within the 2 first days. Endotoxin-induced TNF and IL-6 productions were dramatically impaired in these patients compared with healthy control subjects, whereas an unaltered production was observed with heat-killed Staphylococcus aureus. In contrast, IL-1 receptor antagonist productions were enhanced in these patients compared with healthy control subjects. The productions of T-cell-derived IL-10 and interferon-gamma were also impaired in these patients. Finally, using in vitro plasma exchange between healthy control subjects and patients, we demonstrated that the endotoxin-dependent hyporeactivity was an intrinsic property of patients' leukocytes and that an immunosuppressive activity was also present in their plasma. Altogether, the high levels of circulating cytokines, the presence of endotoxin in plasma, and the dysregulated production of cytokines found in these patients recall the immunological profile found in patients with sepsis.

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Journal

Journal ID (publisher-id): acb

Title: Acta Cirúrgica Brasileira

Abbreviated Title: Acta Cir. Bras.

Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (São Paulo, SP, Brazil )

ISSN (Print): 0102-8650

ISSN (Electronic): 1678-2674

Publication date (Print and electronic): July 2017

Volume: 32

Issue: 7

Pages: 523-532

Affiliations

[1] Beijing orgnameCapital Medical University orgdiv1Beijing Chao-Yang Hospital orgdiv2Department of Emergency China

[2] Beijing orgnameCapital Medical University orgdiv1Beijing Chao-Yang Hospital orgdiv2Department of Emergency China

[3] Beijing orgnameCapital Medical University orgdiv1Beijing Chao-Yang Hospital orgdiv2Department of Emergency China

[4] orgnameBeijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation China

Article

Publisher ID: S0102-86502017000700523 Publisher ID: S0102-8650(17)03200700523

DOI: 10.1590/s0102-865020170070000003

PubMed ID: 28793036

SO-VID: cc866416-dd9a-44b2-9549-ae10f03d40d9

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This work is licensed under a Creative Commons Attribution 4.0 International License.

History

Date received : 14 March 2017

Date accepted : 19 June 2017

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Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 10

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Effect of mild hypothermia on renal ischemia/reperfusion injury after cardiopulmonary resuscitation in a swine model

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Most cited references 24

World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.

Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.

Successful cardiopulmonary resuscitation after cardiac arrest as a "sepsis-like" syndrome.

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