TY - JOUR
T1 - Development and testing of portable pump for the induction of profound hypothermia in a swine model of lethal vascular injuries
AU - Alam, Hasan B.
AU - Casas, Fernando
AU - Chen, Zhang
AU - Smith, William A.
AU - Reeves, Andrew
AU - Velmahos, George
AU - De Moya, Marc
AU - Rhee, Peter
PY - 2006/12
Y1 - 2006/12
N2 - Rapid induction of a profound hypothermic state (suspended animation) can maintain viability of key organs during repair of lethal injuries. Conventional cardiopulmonary bypass equipment (roller pump) used to induce and reverse hypothermia is expensive, bulky, requires standard electricity, and is not transportable. Development of a small, portable, battery operated, disposable, pump can logistically facilitate induction and maintenance of hypothermia. In this experiment, a portable prototype pump was tested and its performance was compared with the regular roller pump in a swine model of lethal vascular injuries. METHODS: Uncontrolled hemorrhage was induced in 16 swine (80-120 lbs) by creating an iliac artery and vein injury (nonlethal). After 30 minutes of pulseless shock, the descending thoracic aorta was lacerated (lethal injury). Through a left thoracotomy approach, a catheter was placed in the aorta and cold organ preservation solution was infused to rapidly (2°C/min) induce hypothermia (10°C) for 60 minutes. The performance of the prototype pump was initially tested in a nonsurvival experiment (four animals). Then, 12 animals were cooled either with (n = 6/group) (1) conventional roller pump or (2) small prototype pump. The injuries were repaired during hypothermic arrest and the animals were re-warmed (0.5°C/min). Whole blood was infused during resuscitation on cardiopulmonary bypass. Surviving animals were closely monitored for 3 weeks for postoperative complications, neurologic deficits, and organ dysfunction. RESULTS: The flow rates and the time needed to induce and reverse profound hypothermia were no different between the prototype and the conventional roller pumps. Three-week survival rates were 83% in both groups. Only a transient increase in liver enzymes, and markers of cellular injury (creatine kinase, lactate dehydrogenase) was noted (no meaningful difference between groups), with no long-term organ dysfunction. CONCLUSIONS: In this large animal model of lethal vascular injuries, a portable, battery operated, disposable, rotary pump performed as well as the conventional roller pump. The logistical advantages of this system make it an attractive choice for inducing hypothermia in emergency departments and austere settings, and for maintaining hypothermia during transport.
AB - Rapid induction of a profound hypothermic state (suspended animation) can maintain viability of key organs during repair of lethal injuries. Conventional cardiopulmonary bypass equipment (roller pump) used to induce and reverse hypothermia is expensive, bulky, requires standard electricity, and is not transportable. Development of a small, portable, battery operated, disposable, pump can logistically facilitate induction and maintenance of hypothermia. In this experiment, a portable prototype pump was tested and its performance was compared with the regular roller pump in a swine model of lethal vascular injuries. METHODS: Uncontrolled hemorrhage was induced in 16 swine (80-120 lbs) by creating an iliac artery and vein injury (nonlethal). After 30 minutes of pulseless shock, the descending thoracic aorta was lacerated (lethal injury). Through a left thoracotomy approach, a catheter was placed in the aorta and cold organ preservation solution was infused to rapidly (2°C/min) induce hypothermia (10°C) for 60 minutes. The performance of the prototype pump was initially tested in a nonsurvival experiment (four animals). Then, 12 animals were cooled either with (n = 6/group) (1) conventional roller pump or (2) small prototype pump. The injuries were repaired during hypothermic arrest and the animals were re-warmed (0.5°C/min). Whole blood was infused during resuscitation on cardiopulmonary bypass. Surviving animals were closely monitored for 3 weeks for postoperative complications, neurologic deficits, and organ dysfunction. RESULTS: The flow rates and the time needed to induce and reverse profound hypothermia were no different between the prototype and the conventional roller pumps. Three-week survival rates were 83% in both groups. Only a transient increase in liver enzymes, and markers of cellular injury (creatine kinase, lactate dehydrogenase) was noted (no meaningful difference between groups), with no long-term organ dysfunction. CONCLUSIONS: In this large animal model of lethal vascular injuries, a portable, battery operated, disposable, rotary pump performed as well as the conventional roller pump. The logistical advantages of this system make it an attractive choice for inducing hypothermia in emergency departments and austere settings, and for maintaining hypothermia during transport.
KW - Bypass
KW - Hypothermia
KW - Lethal hemorrhage
KW - Portable
KW - Pump
KW - Shock
KW - Survival
KW - Vascular injuries
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U2 - 10.1097/01.ta.0000244414.76523.d8
DO - 10.1097/01.ta.0000244414.76523.d8
M3 - Article
C2 - 17159672
AN - SCOPUS:33845751482
SN - 0022-5282
VL - 61
SP - 1321
EP - 1329
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 6
ER -