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In vitro Assessment of Myocardial Protection following Hypothermia-Preconditioning in a Human Cardiac Myocytes Model
Published on: October 27, 2020
Therapeutic hypothermia applicable to cardiac surgery
1Central Laboratory Animal Facility, Hannover Medical School, Hannover, Germany.
Insights
Therapeutic hypothermia (TH) is crucial for neuroprotection during cardiac surgery. Mild to moderate cooling (32-36°C) via intravascular methods during cardiopulmonary bypass (CPB) offers benefits while minimizing adverse effects.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Critical Care Medicine
Background:
- Therapeutic hypothermia (TH) is increasingly recognized for its neuroprotective potential.
- Cardiac surgery with cardiopulmonary bypass (CPB) presents unique challenges for maintaining optimal patient temperature.
- Understanding the balance between beneficial and adverse effects of TH is critical for patient outcomes.
Purpose of the Study:
- To comprehensively review the beneficial and adverse effects of therapeutic hypothermia (TH).
- To evaluate various temperature levels and techniques for achieving TH in cardiac surgery with CPB.
- To provide evidence-based guidance on the optimal application of TH for neuroprotection.
Main Methods:
- Extensive literature searches were conducted in PubMed and Google for articles published between June 2012 and December 2014.
- Relevant keywords including 'hypothermia', 'cardiopulmonary bypass', 'cardiac surgery', and 'neuroprotection' were utilized.
- References from identified studies were also screened to ensure comprehensive data retrieval, excluding abstracts and case reports.
Main Results:
- Intravascular cooling utilizing hypothermic cardiopulmonary bypass (CPB) emerged as the most effective method for achieving therapeutic hypothermia (TH).
- Mild to moderate hypothermia, specifically between 32°C and 36°C, was found to be sufficient for neuroprotection in most cardiac surgical procedures.
- Lower body core temperatures were associated with a higher incidence of adverse hypothermic effects.
Conclusions:
- Therapeutic hypothermia (TH) is an indispensable neuroprotective strategy in cardiac surgery performed with cardiopulmonary bypass (CPB).
- Optimal neuroprotection and minimization of adverse effects are achieved with mild to moderate hypothermia (32-36°C) using intravascular cooling techniques.
- Careful management of temperature during CPB is essential for maximizing the benefits of TH while mitigating risks.
Objective:
To review the beneficial and adverse effects of therapeutic hypothermia (TH) applicable to cardiac surgery with cardiopulmonary bypass (CPB) in the contexts of various temperature levels and techniques for achieving TH.
Databases Used:
Multiple electronic literature searches were performed using PubMed and Google for articles published from June 2012 to December 2014. Relevant terms (e.g. 'hypothermia', 'cardiopulmonary bypass', 'cardiac surgery', 'neuroprotection') were used to search for original articles, letters and reviews without species limitation. Reviews were included despite potential publication bias. References from the studies identified were also searched to find other potentially relevant citations. Abstracts, case reports, conference presentations, editorials and expert opinions were excluded.
Conclusions:
Therapeutic hypothermia is an essential measure of neuroprotection during cardiac surgery that may be achieved most effectively by intravascular cooling using hypothermic CPB. For most cardiac surgical procedures, mild to modest (32-36 °C) TH will be sufficient to assure neuroprotection and will avoid most of the adverse effects of hypothermia that occur at lower body core temperatures.
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