The effect of mild hypothermia on multiple organ dysfunction system post-cardiac surgery: a case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Xiaoqi ,  GU Tianxiang , XIU Zongyi , YU Lei , QIAN Cheng

Department of Cardiac Surgery, The First Affiliated Hospital of China Medical University, Shenyang , 110001, P.R.China;

Corresponding?author：

GU Tianxiang, Email: cmugtx@sina.com

Keywords：

Hypothermia; multiple organ failure; cardiogenic shock

DOI：

10.7507/1007-4848.201512012

Video：

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Objective To summarize the effect of mild hypothermia on post-cardiac surgery patients with multiple organ dysfunction system(MODS). Methods We retrospectively analyzed the clinical data of 90 patients with MODS after cardiac surgery under cardiopulmonary bypass(CPB) from May 2010 through June 2014 in our hospital. There were 57 males and 33 females at 61±6 years. The patients were divided into two groups including a NT group (without pre-hypothermia treatment,n=32) and a HT group(with pre-hypothermia treatment,n=58). Results Of the 90 patients, totally 18 patients died, 8 patients (13.8%) in the HT group, 10 patients (31.2%) in the NT group with a statistical difference (P<0.05). In the NT group, 12 patients (37.5%) were treated by intra-aortic balloon pump (IABP), and 9 patients (15.5%) in the HT group with a statistical difference between the two groups (P<0.05). The patients' heart rate (HR) decreased significantly after the application of hypothermia. The HR of difference between the two groups at 36 h was significant (P<0.05). The mean aortic pressure (MAP) in the HT group was lower than that of the NT group significantly at 0 h, because we used sedation and muscular relaxation agent. But the MAP in the HT group was significantly higher than that of the NT group after hypothermia 36 h (P<0.05). In the HT group, pressure of oxygen (PO₂), mixed venous oxygen saturation (SvO₂), and lactic acid (Lac) were improved significantly compared with those of the NT group significantly (P<0.05). There was no statistical difference in prothrombin time (PT) or activated partial thromboplastin time (APTT) between the two groups (P>0.05). But there was a statistical difference in platelet (PLT) between the two groups at 36 h (P<0.05). The aspartate aminotransferase (AST), alannine aminotransferase (ALT), creatinine (Cr) were improved significantly in the HT group (P<0.05). Conclusion Mild hypothermia can improve the organ function effectively. It can slow the MODS development speed and win the time of protection and further treatment for cells and organs. It is an effective and safety therapeutic technique for MODS after cardiac surgery.

Citation： ZHAO Xiaoqi, GU Tianxiang, XIU Zongyi, YU Lei, QIAN Cheng. The effect of mild hypothermia on multiple organ dysfunction system post-cardiac surgery: a case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(3): 201-205. doi: 10.7507/1007-4848.201512012 Copy

1.	?Kirklin JK, Westaby S, Blackstone EH, et al. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1983, 86(6): 845-857.
2.	Kunes P, Lonsky V, Mand’ak J, et al. The inflammatory response in cardiac surgery. An up-to-date overview with the emphasis on the role of heat shock proteins(HSPs)60 and 70. Acta Medica (Hradec Kralove), 2007, 50(1): 93-99.
3.	Boeken U, Feindt P, Zimmermann N, et al. Increased preoperative C-reactive protein (CRP)-values without signs of an infection and complicated course after cardiopulmonary bypass(CPB)-operations. Eur J Cardiothorac Surg, 1998, 13(5): 541-545.
4.	American Colledge of Chest Physicians/society of Critical Care Medicine Consensus Conference: Definition for sepsis and organ failure and guideline for the use of innovative therapies in sepsis. Crit Care Med, 1992, 20: 864-874.
5.	Khadaroo RG, Marshall JC. ARDS and the multiple organ dysfunction syndrome. Common mechanisms of a common systemic process. Crit Care Clin, 2002, 18(1): 127-141.
6.	Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: Results of the SOAP study. Crit Care Med, 2006, 34(2): 344-353.
7.	Nfor TK, Walsh TS, Prescott RJ. The impact of organ failures and their relationship with outcome in intensive care: Analysis of a prospective multicentre database of adult admissions. Anaesthesia, 2006, 61(8): 731-738.
8.	Umegaki T, Ikai H, Imanaka Y. The impact of acute organ dysfunction on patients’ mortality with severe sepsis. J Anaesthesiol Clin Pharmacol, 2011, 27(2): 180-184.
9.	Tissier R, Chenoune M, Ghaleh B, et al. The small chill: Mild hypothermia for cardioprotection? Cardiovasc Res, 2010, 88(3): 406-414.
10.	Birdi I, Caputo M, Underwood M, et al. Influence of normothermic systemic perfusion temperature on cold myocardial protection during coronary artery bypass surgery. Cardiovasc Surg, 1999, 7(3): 369-374.
11.	Lewis ME, Alkhalidi AH, Townend JN, et al. The effects of hypothermia on human left ventricular contractile function during cardiac surgery. J Am Cell Cardiol, 2002, 39(1): 102-108.
12.	Gilbert NF, Meyer PE, Tauriainen MP, et al. Effects of hypothermia on myocardial substrate selection. Ann Thorac Surg, 2002, 74(4): 1208-1212.
13.	Buckberg RD, Brazier JR, Nelson RI. Studies of the effects of hypothermia on reginal myocardial blood flow and metabolism during cardiopulmonary bypass-I. The adequately perfused beating, fibrillating, and arrested heart. J Thorac Cardiovasc Surg, 1977, 73(1): 89-94.
14.	Ning XH, Xu CS, Portman MA. Mitochondrial protein and HSP70 signaling after ischemia in hypothermic-adapted hearts augmented with glucose. Am J Physiol, 1999, 277(1 Pt 2): R11-R17.
15.	Kim CY, Bae MH, Kim NF, et al. Case of recurrent ventricular fibrillations with Osborn wave developed during therapeutic hypothermia. Korean Circ J, 2015, 45(1): 81-84.
16.	Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med, 2002, 346(8): 557-563.
17.	Sablotzki A, Friedrich I, Muhling J, et al. The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multi organ dysfunction. Perfusion, 2002, 17: 103-109.
18.	Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult Should current practice be changed? J Thorac Cardiacvasc Surg, 2003, 125(6): 1438-1450.
19.	Herring MJ, Hale SL, Daiw, et al. Hypothermia in the setting of experimental acute myocardial infarction: a comprehensive review. Ther Hypothermia Temp Manag, 2014, 4(4): 159-167.
20.	Ristagno G, Tantillo S, Sun S, et al. Hypothermia improves ventricular myocyte contractility under conditions of normal perfusion and after an interval of ischemia. Resuscitation, 2010, 81(7): 898-903.
21.	Suga H, Goto Y, Igarashi Y, et al. Cardiac cooling increases Emax without affecting relation between O₂ consumption and systolic pressure-volume area in dog left ventricle. Circ Res, 1998, 63(1): 61-71.

1. ?Kirklin JK, Westaby S, Blackstone EH, et al. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1983, 86(6): 845-857.
2. Kunes P, Lonsky V, Mand’ak J, et al. The inflammatory response in cardiac surgery. An up-to-date overview with the emphasis on the role of heat shock proteins(HSPs)60 and 70. Acta Medica (Hradec Kralove), 2007, 50(1): 93-99.
3. Boeken U, Feindt P, Zimmermann N, et al. Increased preoperative C-reactive protein (CRP)-values without signs of an infection and complicated course after cardiopulmonary bypass(CPB)-operations. Eur J Cardiothorac Surg, 1998, 13(5): 541-545.
4. American Colledge of Chest Physicians/society of Critical Care Medicine Consensus Conference: Definition for sepsis and organ failure and guideline for the use of innovative therapies in sepsis. Crit Care Med, 1992, 20: 864-874.
5. Khadaroo RG, Marshall JC. ARDS and the multiple organ dysfunction syndrome. Common mechanisms of a common systemic process. Crit Care Clin, 2002, 18(1): 127-141.
6. Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: Results of the SOAP study. Crit Care Med, 2006, 34(2): 344-353.
7. Nfor TK, Walsh TS, Prescott RJ. The impact of organ failures and their relationship with outcome in intensive care: Analysis of a prospective multicentre database of adult admissions. Anaesthesia, 2006, 61(8): 731-738.
8. Umegaki T, Ikai H, Imanaka Y. The impact of acute organ dysfunction on patients’ mortality with severe sepsis. J Anaesthesiol Clin Pharmacol, 2011, 27(2): 180-184.
9. Tissier R, Chenoune M, Ghaleh B, et al. The small chill: Mild hypothermia for cardioprotection? Cardiovasc Res, 2010, 88(3): 406-414.
10. Birdi I, Caputo M, Underwood M, et al. Influence of normothermic systemic perfusion temperature on cold myocardial protection during coronary artery bypass surgery. Cardiovasc Surg, 1999, 7(3): 369-374.
11. Lewis ME, Alkhalidi AH, Townend JN, et al. The effects of hypothermia on human left ventricular contractile function during cardiac surgery. J Am Cell Cardiol, 2002, 39(1): 102-108.
12. Gilbert NF, Meyer PE, Tauriainen MP, et al. Effects of hypothermia on myocardial substrate selection. Ann Thorac Surg, 2002, 74(4): 1208-1212.
13. Buckberg RD, Brazier JR, Nelson RI. Studies of the effects of hypothermia on reginal myocardial blood flow and metabolism during cardiopulmonary bypass-I. The adequately perfused beating, fibrillating, and arrested heart. J Thorac Cardiovasc Surg, 1977, 73(1): 89-94.
14. Ning XH, Xu CS, Portman MA. Mitochondrial protein and HSP70 signaling after ischemia in hypothermic-adapted hearts augmented with glucose. Am J Physiol, 1999, 277(1 Pt 2): R11-R17.
15. Kim CY, Bae MH, Kim NF, et al. Case of recurrent ventricular fibrillations with Osborn wave developed during therapeutic hypothermia. Korean Circ J, 2015, 45(1): 81-84.
16. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med, 2002, 346(8): 557-563.
17. Sablotzki A, Friedrich I, Muhling J, et al. The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multi organ dysfunction. Perfusion, 2002, 17: 103-109.
18. Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult Should current practice be changed? J Thorac Cardiacvasc Surg, 2003, 125(6): 1438-1450.
19. Herring MJ, Hale SL, Daiw, et al. Hypothermia in the setting of experimental acute myocardial infarction: a comprehensive review. Ther Hypothermia Temp Manag, 2014, 4(4): 159-167.
20. Ristagno G, Tantillo S, Sun S, et al. Hypothermia improves ventricular myocyte contractility under conditions of normal perfusion and after an interval of ischemia. Resuscitation, 2010, 81(7): 898-903.
21. Suga H, Goto Y, Igarashi Y, et al. Cardiac cooling increases Emax without affecting relation between O₂ consumption and systolic pressure-volume area in dog left ventricle. Circ Res, 1998, 63(1): 61-71.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The effect of mild hypothermia on multiple organ dysfunction system post-cardiac surgery: a case control study

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