Abstract 76: Early Institution of Hypothermic Total Liquid Ventilation After Prolonged Cardiac Arrest Protects Against Kidney Ischemic Alterations
Introduction: Warm ischemia before organ removal is a major cause of kidney alterations in transplants from non-heart-beating donors. In a rabbit model of cardiac arrest (CA), we showed that rapid cooling using total liquid ventilation (TLV) can improve survival and protect heart and brain after resuscitation.
Hypothesis: We hypothesized that TLV with perfluorocarbons can also limits kidney alterations after CA, with potential applications for controlled organ donation in the Maastricht III category.
Methods: Anesthetized rabbits were submitted to 15 min of untreated ventricular fibrillation. After resuscitation and resumption of spontaneous circulation (ROSC), rabbits underwent Control life support or hypothermia (32-33°C) induced by TLV and maintained with external blankets under mechanical ventilation. Life support was prolonged during 6 h before kidney removal and analysis. Other rabbits were submitted to similar follow-up with no CA (Sham group).
Results: In each group, 8 animals completed the protocol. Despite similar delays before ROSC (∼4 min), epinephrine doses required to maintain blood pressure throughout follow-up were lower in TLV vs Control (361±23 vs 990±179 µg/kg, respectively). This was accompanied by a decrease in creatinine blood levels after CA (12±1 vs 16±2 mg/l), while still altered when compared to Sham values (8±1 mg/l). Importantly, kidney lesions were also attenuated in TLV vs Control (Figure). The nephroprotective effect of TLV was not related to differences in delayed inflammatory or immune renal responses since transcriptions of, e.g., IFN-γ, TNF-α, IL-1β, MCP-1, TLR-2, TLR-4, VEGF, ICAM-1 and E-selectin were similarly altered in TLV and Control vs Sham. An immediate anti-ischemic effect of rapid cooling with TLV might accordingly be involved.
Conclusion: Ultra-fast cooling with TLV limits kidney alterations after prolonged experimental CA.
*, p<0.05 vs Sham; †, p<0.05 vs Control.
- © 2012 by American Heart Association, Inc.