Direct cerebral perfusion and cooling in experimental cardiac arrest

Rinaldo Bellomo, Bruno Marino, Peter Angelopoulos, Scott Carson, Glenn Eastwood, Junko Kosaka, Naoya Iguchi, Andrew Hilton, Clive May

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Cerebral protection is a key priority during cardiac arrest (CA). However, current approaches are suboptimal. Objective: To test whether direct perfusion and cooling of the anterior cerebral circulation by means of cerebral vessel cannulation and extracorporeal membrane oxygenation (ECMO) increases cerebral oxygenation and induces cerebral hypothermia during CA. Methods: We performed proof-of-concept animal experiments in sheep. We cannulated the carotid artery (for antegrade perfusion) or the jugular vein (for retrograde perfusion) for direct perfusion and cooling, and the jugular vein on the opposite side for drainage. We connected these cannulae to an ECMO circuit. We induced CA and, after 10 minutes, and during open-chest cardiac massage, we provided ECMO-based perfusion and cooling. We measured cerebral tissue oxygen saturation (SctO2) by near infrared spectroscopy (NIRS) and cerebral temperature by means of invasively inserted tissue temperature probes. Results: In the antegrade perfusion experiments (n = 2), CA markedly decreased the SctO2 to below 40% over 10 minutes, despite open-chest cardiac massage. ECMO-based cerebral perfusion and cooling increased SctO2 levels to 60% and lowered cerebral temperature to 25°C within about 3 minutes. With retrograde perfusion (n = 2), ECMO-based cerebral perfusion and cooling was less effective; ECMO increased SctO2 levels slowly and to a much lesser extent and similarly decreased cerebral temperature slowly and to a lesser extent. Conclusions: During experimental CA, cerebral perfusion and cooling are possible by means of an ECMO circuit connected to the anterior cerebral circulation. Antegrade perfusion appears to be superior. Further investigations of the antegrade perfusion technique appear justified.

Original languageEnglish
Pages (from-to)255-260
Number of pages6
JournalCritical Care and Resuscitation
Volume18
Issue number4
Publication statusPublished - Dec 2016
Externally publishedYes

Cite this

Bellomo, R., Marino, B., Angelopoulos, P., Carson, S., Eastwood, G., Kosaka, J., ... May, C. (2016). Direct cerebral perfusion and cooling in experimental cardiac arrest. Critical Care and Resuscitation, 18(4), 255-260.
Bellomo, Rinaldo ; Marino, Bruno ; Angelopoulos, Peter ; Carson, Scott ; Eastwood, Glenn ; Kosaka, Junko ; Iguchi, Naoya ; Hilton, Andrew ; May, Clive. / Direct cerebral perfusion and cooling in experimental cardiac arrest. In: Critical Care and Resuscitation. 2016 ; Vol. 18, No. 4. pp. 255-260.
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Bellomo, R, Marino, B, Angelopoulos, P, Carson, S, Eastwood, G, Kosaka, J, Iguchi, N, Hilton, A & May, C 2016, 'Direct cerebral perfusion and cooling in experimental cardiac arrest', Critical Care and Resuscitation, vol. 18, no. 4, pp. 255-260.

Direct cerebral perfusion and cooling in experimental cardiac arrest. / Bellomo, Rinaldo; Marino, Bruno; Angelopoulos, Peter; Carson, Scott; Eastwood, Glenn; Kosaka, Junko; Iguchi, Naoya; Hilton, Andrew; May, Clive.

In: Critical Care and Resuscitation, Vol. 18, No. 4, 12.2016, p. 255-260.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Direct cerebral perfusion and cooling in experimental cardiac arrest

AU - Bellomo, Rinaldo

AU - Marino, Bruno

AU - Angelopoulos, Peter

AU - Carson, Scott

AU - Eastwood, Glenn

AU - Kosaka, Junko

AU - Iguchi, Naoya

AU - Hilton, Andrew

AU - May, Clive

PY - 2016/12

Y1 - 2016/12

N2 - Background: Cerebral protection is a key priority during cardiac arrest (CA). However, current approaches are suboptimal. Objective: To test whether direct perfusion and cooling of the anterior cerebral circulation by means of cerebral vessel cannulation and extracorporeal membrane oxygenation (ECMO) increases cerebral oxygenation and induces cerebral hypothermia during CA. Methods: We performed proof-of-concept animal experiments in sheep. We cannulated the carotid artery (for antegrade perfusion) or the jugular vein (for retrograde perfusion) for direct perfusion and cooling, and the jugular vein on the opposite side for drainage. We connected these cannulae to an ECMO circuit. We induced CA and, after 10 minutes, and during open-chest cardiac massage, we provided ECMO-based perfusion and cooling. We measured cerebral tissue oxygen saturation (SctO2) by near infrared spectroscopy (NIRS) and cerebral temperature by means of invasively inserted tissue temperature probes. Results: In the antegrade perfusion experiments (n = 2), CA markedly decreased the SctO2 to below 40% over 10 minutes, despite open-chest cardiac massage. ECMO-based cerebral perfusion and cooling increased SctO2 levels to 60% and lowered cerebral temperature to 25°C within about 3 minutes. With retrograde perfusion (n = 2), ECMO-based cerebral perfusion and cooling was less effective; ECMO increased SctO2 levels slowly and to a much lesser extent and similarly decreased cerebral temperature slowly and to a lesser extent. Conclusions: During experimental CA, cerebral perfusion and cooling are possible by means of an ECMO circuit connected to the anterior cerebral circulation. Antegrade perfusion appears to be superior. Further investigations of the antegrade perfusion technique appear justified.

AB - Background: Cerebral protection is a key priority during cardiac arrest (CA). However, current approaches are suboptimal. Objective: To test whether direct perfusion and cooling of the anterior cerebral circulation by means of cerebral vessel cannulation and extracorporeal membrane oxygenation (ECMO) increases cerebral oxygenation and induces cerebral hypothermia during CA. Methods: We performed proof-of-concept animal experiments in sheep. We cannulated the carotid artery (for antegrade perfusion) or the jugular vein (for retrograde perfusion) for direct perfusion and cooling, and the jugular vein on the opposite side for drainage. We connected these cannulae to an ECMO circuit. We induced CA and, after 10 minutes, and during open-chest cardiac massage, we provided ECMO-based perfusion and cooling. We measured cerebral tissue oxygen saturation (SctO2) by near infrared spectroscopy (NIRS) and cerebral temperature by means of invasively inserted tissue temperature probes. Results: In the antegrade perfusion experiments (n = 2), CA markedly decreased the SctO2 to below 40% over 10 minutes, despite open-chest cardiac massage. ECMO-based cerebral perfusion and cooling increased SctO2 levels to 60% and lowered cerebral temperature to 25°C within about 3 minutes. With retrograde perfusion (n = 2), ECMO-based cerebral perfusion and cooling was less effective; ECMO increased SctO2 levels slowly and to a much lesser extent and similarly decreased cerebral temperature slowly and to a lesser extent. Conclusions: During experimental CA, cerebral perfusion and cooling are possible by means of an ECMO circuit connected to the anterior cerebral circulation. Antegrade perfusion appears to be superior. Further investigations of the antegrade perfusion technique appear justified.

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Bellomo R, Marino B, Angelopoulos P, Carson S, Eastwood G, Kosaka J et al. Direct cerebral perfusion and cooling in experimental cardiac arrest. Critical Care and Resuscitation. 2016 Dec;18(4):255-260.