Rapidly induced selective cerebral hypothermia using a cold carotid arterial flush during cardiac arrest in a dog model

PURPOSE: The present study was undertaken to determine whether flushing the carotid artery with normal saline at 4 degrees C (hypothermic carotid arterial flush, HCAF) during cardiac arrest can achieve selective cerebral hypothermia rapidly during cardiac arrest and improve cerebral outcome. METHODS: Ventricular fibrillation (VF) was induced in fourteen dogs and circulatory arrest was maintained for 9 min. Dogs were then resuscitated by cardiopulmonary resuscitation. The dogs were divided into two groups; a control group (n=7), which underwent precisely the same procedure as the experimental group but not HCAF, and an experimental group (HCAF group; n=7), which received HCAF from 8 min after the onset of VF. RESULTS: Two dogs in the control group and in the HCAF group died within 72 h after the recovery of spontaneous circulation (ROSC) due to extracerebral complications. The remaining 10 dogs survived to final evaluation at 72 h post-ROSC. In the HCAF group, tympanic temperature decreased from 37.7 degrees C (37.5-37.8) to 34 degrees C in 1 min (1-1.5) from the start of HCAF and was maintained below 34 degrees C until 6.5 min (3-12) after the start of HCAF, whereas oesophageal and rectal temperatures were maintained above 35 degrees C. Neurological deficit scores (0-100%) at 72 h post-ROSC were 42.4% (27.0-80.6) in the control group and 18.4% (14.0-36.0) in the HCAF group (p<0.05). CONCLUSION: HCAF induced selective cerebral hypothermia rapidly during cardiac arrest and improved neurological deficit scores after 9 min of no blood flow in the described canine cardiac arrest model.