Transpulmonary hypothermia: A novel method of rapid brain cooling through augmented heat extraction from the lungs

Matthew M. Kumar, Andrew D. Goldberg, Markos Kashiouris, Lawrence R. Keenan, Alejandro Rabinstein, Bekele Afessa, Larry D. Johnson, John L D Atkinson, Vedha Nayagam

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Aim: Delay in instituting neuroprotective measures after cardiac arrest increases death and decreases neuronal recovery. Current hypothermia methods are slow, ineffective, unreliable, or highly invasive. We report the feasibility of rapid hypothermia induction in swine through augmented heat extraction from the lungs. Methods: Twenty-four domestic crossbred pigs (weight, 50-55. kg) were ventilated with room air. Intraparenchymal brain temperature and core temperatures from pulmonary artery, lower esophagus, bladder, rectum, nasopharynx, and tympanum were recorded. In eight animals, ventilation was switched to cooled helium-oxygen mixture (heliox) and perfluorocarbon (PFC) aerosol and continued for 90. min or until target brain temperature of 32. °C was reached. Eight animals received body-surface cooling with water-circulating blankets; eight control animals continued to be ventilated with room air. Results: Brain and core temperatures declined rapidly with cooled heliox-PFC ventilation. The brain reached target temperature within the study period (mean [SD], 66 [7.6]. min) in only the transpulmonary cooling group. Cardiopulmonary functions and poststudy histopathological examination of the lungs were normal. Conclusion: Transpulmonary cooling is novel, rapid, minimally invasive, and an effective technique to induce therapeutic hypothermia. High thermal conductivity of helium and vaporization of PFC produces rapid cooling of alveolar gases. The thinness and large surface area of alveolar membrane facilitate rapid cooling of the pulmonary circulation. Because of differences in thermogenesis, blood flow, insulation, and exposure to the external environment, the brain cools at a different rate than other organs. Transpulmonary hypothermia was significantly faster than body surface cooling in reaching target brain temperature.

Original languageEnglish (US)
Pages (from-to)1405-1410
Number of pages6
JournalResuscitation
Volume85
Issue number10
DOIs
StatePublished - Oct 1 2014

Fingerprint

Hypothermia
Hot Temperature
Fluorocarbons
Lung
Helium
Temperature
Brain
Ventilation
Air
Oxygen
Thermal Conductivity
Induced Hypothermia
Sus scrofa
Volatilization
Pulmonary Circulation
Nasopharynx
Thinness
Thermogenesis
Middle Ear
Heart Arrest

Keywords

  • Cardiopulmonary resuscitation
  • Heliox ventilation
  • Induced hypothermia
  • Neuroprotection
  • Perfluorocarbon
  • Transpulmonary hypothermia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

Transpulmonary hypothermia : A novel method of rapid brain cooling through augmented heat extraction from the lungs. / Kumar, Matthew M.; Goldberg, Andrew D.; Kashiouris, Markos; Keenan, Lawrence R.; Rabinstein, Alejandro; Afessa, Bekele; Johnson, Larry D.; Atkinson, John L D; Nayagam, Vedha.

In: Resuscitation, Vol. 85, No. 10, 01.10.2014, p. 1405-1410.

Research output: Contribution to journalArticle

Kumar, MM, Goldberg, AD, Kashiouris, M, Keenan, LR, Rabinstein, A, Afessa, B, Johnson, LD, Atkinson, JLD & Nayagam, V 2014, 'Transpulmonary hypothermia: A novel method of rapid brain cooling through augmented heat extraction from the lungs', Resuscitation, vol. 85, no. 10, pp. 1405-1410. https://doi.org/10.1016/j.resuscitation.2014.05.041
Kumar, Matthew M. ; Goldberg, Andrew D. ; Kashiouris, Markos ; Keenan, Lawrence R. ; Rabinstein, Alejandro ; Afessa, Bekele ; Johnson, Larry D. ; Atkinson, John L D ; Nayagam, Vedha. / Transpulmonary hypothermia : A novel method of rapid brain cooling through augmented heat extraction from the lungs. In: Resuscitation. 2014 ; Vol. 85, No. 10. pp. 1405-1410.
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AU - Rabinstein, Alejandro

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AB - Aim: Delay in instituting neuroprotective measures after cardiac arrest increases death and decreases neuronal recovery. Current hypothermia methods are slow, ineffective, unreliable, or highly invasive. We report the feasibility of rapid hypothermia induction in swine through augmented heat extraction from the lungs. Methods: Twenty-four domestic crossbred pigs (weight, 50-55. kg) were ventilated with room air. Intraparenchymal brain temperature and core temperatures from pulmonary artery, lower esophagus, bladder, rectum, nasopharynx, and tympanum were recorded. In eight animals, ventilation was switched to cooled helium-oxygen mixture (heliox) and perfluorocarbon (PFC) aerosol and continued for 90. min or until target brain temperature of 32. °C was reached. Eight animals received body-surface cooling with water-circulating blankets; eight control animals continued to be ventilated with room air. Results: Brain and core temperatures declined rapidly with cooled heliox-PFC ventilation. The brain reached target temperature within the study period (mean [SD], 66 [7.6]. min) in only the transpulmonary cooling group. Cardiopulmonary functions and poststudy histopathological examination of the lungs were normal. Conclusion: Transpulmonary cooling is novel, rapid, minimally invasive, and an effective technique to induce therapeutic hypothermia. High thermal conductivity of helium and vaporization of PFC produces rapid cooling of alveolar gases. The thinness and large surface area of alveolar membrane facilitate rapid cooling of the pulmonary circulation. Because of differences in thermogenesis, blood flow, insulation, and exposure to the external environment, the brain cools at a different rate than other organs. Transpulmonary hypothermia was significantly faster than body surface cooling in reaching target brain temperature.

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